Individual provider · NPI-1

Mikol Robert Anderson, DPM

Podiatrist · Salt Lake City, UT

NPI number1992910905
StatusActive
Last updated in NPPESOct 31, 2008

Details

NPI
1992910905
Entity type
Individual (NPI-1)
Name
Mikol Robert Anderson
Credential
DPM
Sex
Male
Sole proprietor
No
Enumeration date
May 12, 2007
Last updated
Oct 31, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
213E00000X Podiatrist59638310501UTYes

Practice location

1250 E 3900 S
Suite 420
Salt Lake City, UT 84124-1348

Phone 801-269-9939 · Fax 801-269-9949

Mailing address

Po Box 932
Sandy, UT 84091-0932

Phone 801-553-9568 · Fax 801-553-9562

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