Kenneth Paul Anderson, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036.121924 Issued in IL

Practice address

2650 Ridge Ave
Evanston, IL 60201-1718

Phone

(847) 570-2008

NPI assigned

Sep 18, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Kenneth Paul Anderson Jr. Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Endeavor Health Medical Group

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882

  Family Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221696000000",
    "number": "1811146483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KENNETH",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-18",
        "last_updated": "2008-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.121924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENNETH",
            "last_name": "ANDERSON",
            "middle_name": "PAUL",
            "prefix": "DR.",
            "suffix": "JR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chrisantha Ernest Anandappa, M.D.
• Vina Andaya, APN-CNP
• Chad B. Anderson, PA-C
• Emily J Anderson, RN, DNP
• Jill Christina Anderson, M.D.
• Kenton Anderson, ND
• Lauren Anderson, MD
• Patricia Simmons Anderson, P.T.
• Zachary M Anderson, PH.D.
• Justin Ryan Gavino Andrada, D.O.

• Family Medicine Physician in Evanston, IL
• Providers in Evanston, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.