Provider Demographics
NPI:1093725764
Name:NAYLOR, ANDREA H (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:H
Last Name:NAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 CONNABLE AVE
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2212
Mailing Address - Country:US
Mailing Address - Phone:231-487-7129
Mailing Address - Fax:231-487-3082
Practice Address - Street 1:416 CONNABLE AVE
Practice Address - Street 2:ACUTE REHABILITATION UNIT
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2212
Practice Address - Country:US
Practice Address - Phone:231-487-3496
Practice Address - Fax:231-487-3424
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI077046208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B41120OtherBCBSM
MIP52980025Medicare PIN