Provider Demographics
NPI:1033210547
Name:MUZYCHKA, ANDREW B (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:MUZYCHKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36475 5 MILE RD
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1971
Mailing Address - Country:US
Mailing Address - Phone:734-655-1200
Mailing Address - Fax:734-655-1271
Practice Address - Street 1:36475 5 MILE RD
Practice Address - Street 2:MEDICAL STAFF OFFICE
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1971
Practice Address - Country:US
Practice Address - Phone:734-655-1200
Practice Address - Fax:734-655-1271
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4199722Medicaid
MIG59478Medicare UPIN
MI0N12200023Medicare ID - Type Unspecified