1437109816 NPI number — DR. THOMAS MCDOWELL ANDERSON MD

Table of content: TINA SEDERSTEN LIMHP (NPI 1215012208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437109816 NPI number — DR. THOMAS MCDOWELL ANDERSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
THOMAS
Provider Middle Name:
MCDOWELL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437109816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 HOLLISTER DRIVE
Provider Second Line Business Mailing Address:
SUITE G-18
Provider Business Mailing Address City Name:
LIBERTYVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60048-5264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-918-1462
Provider Business Mailing Address Fax Number:
847-968-4311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 HOLLISTER DRIVE
Provider Second Line Business Practice Location Address:
SUITE G-18
Provider Business Practice Location Address City Name:
LIBERTYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60048-5264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-918-1462
Provider Business Practice Location Address Fax Number:
847-968-4311
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  35.090033 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 01060007A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 036-044542 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 46433-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036044542 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34634500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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