Anderson, Tynese Simone
Anderson, Tynese Simone is an sole proprietor health care provider with primary practice located at 1021 W 5Th Ave , Gary IN 46402-1703. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Anderson, Tynese Simone can be contacted via phone (219) 880-1190.Contact Information
Primary practice address
1021 W 5Th Ave
Gary IN 46402-1703
Phone: (219) 880-1190
Fax: (219) 378-7147
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 01084389A | Indiana |
Profile Details
| NPI number | 1528327731 |
|---|---|
| LBN Legal business name | Anderson, Tynese Simone |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 8th, 2012 |
| Last updated | Jan 29th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528327731 | NPPES |
| Indiana | Other | 300042215 | INDIANA LPI |
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