Basic Information
Provider Information
NPI: 1396712089
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDERSON
FirstName: KAREN
MiddleName: SUE
NamePrefix:  
NameSuffix:  
Credential: MD PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13400 E SHEA BLVD
Address2:  
City: SCOTTSDALE
State: AZ
PostalCode: 852595452
CountryCode: US
TelephoneNumber: 4803018000
FaxNumber:  
Practice Location
Address1: 13400 E SHEA BLVD
Address2:  
City: SCOTTSDALE
State: AZ
PostalCode: 852595452
CountryCode: US
TelephoneNumber: 4803018000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/02/2006
LastUpdateDate: 09/09/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/09/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X152136MAN Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
207RH0003X45595AZY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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