Mikol Robert Anderson, DPM
Individual provider Active NPI Podiatrist · Salt Lake City, UT
NPI 1992910905 · NPPES record last updated Oct 31, 2008
Key facts
- NPI
- 1992910905
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- 59638310501 (UT)
- Practice address
- 1250 E 3900 S
Suite 420
Salt Lake City, UT 84124-1348 - Phone
- (801) 269-9939
- Fax
- (801) 269-9949
- NPI assigned
- May 12, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
-
Francis J Clark, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070806000519 | UT | Practitioner - Podiatry | 0648361659 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59638310501 | UT | MD | Podiatrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 59638310501 | UT | Yes |
Addresses
Primary practice location
1250 E 3900 S
Suite 420
Salt Lake City, UT 84124-1348
Mailing address
PO Box 932
Sandy, UT 84091-0932
Phone (801) 553-9568
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992910905 | Medicaid | UT |
Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.