Provider Demographics
NPI:1053315325
Name:SLOAN, ANDREA MARY (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARY
Last Name:SLOAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARY
Other - Last Name:DEMRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4967 CROOKS RD
Mailing Address - Street 2:STE 130
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5801
Mailing Address - Country:US
Mailing Address - Phone:248-952-1601
Mailing Address - Fax:248-952-0192
Practice Address - Street 1:4967 CROOKS RD
Practice Address - Street 2:STE 130
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-5801
Practice Address - Country:US
Practice Address - Phone:248-952-1601
Practice Address - Fax:248-952-0192
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070152207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4846370Medicaid
MIAD070152OtherBCBSM
MI1053315325OtherNPI #
MI70-0-F32947-0OtherBCBS CPIN #
MIP28070039Medicare PIN
MI4846370Medicaid