Gregg W. Anderson, M.D.
Individual provider Active NPI Specialist · Coon Rapids, MN
NPI 1962477323 · NPPES record last updated Apr 23, 2012
Key facts
- NPI
- 1962477323
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 25801 (MN)
- Practice address
- 516 Delaware St SE
Clinic 1E
Coon Rapids, MN 55455 - Phone
- (612) 624-5915
- NPI assigned
- Feb 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Minnesota Physicians | Past | Accepting new patients | |
| Twin Cities Heart & Lung, P.a. | Specialist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 25801 | MN | Yes |
Addresses
Primary practice location
516 Delaware St SE
Clinic 1E
Coon Rapids, MN 55455
Mailing address
720 Washington Av SE
200
Minneapolis, MN 55414-1321
Phone (612) 884-0649
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 271802200 | Medicaid | MN |
Other providers in Coon Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.