Provider Demographics
NPI:1164487104
Name:HOMA, ANDREW (MD)
Entity Type:Individual
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First Name:ANDREW
Middle Name:
Last Name:HOMA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:812 E JOLLY RD
Mailing Address - Street 2:STE 210
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6818
Mailing Address - Country:US
Mailing Address - Phone:517-346-8410
Mailing Address - Fax:517-346-8291
Practice Address - Street 1:5303 S CEDAR ST
Practice Address - Street 2:STE 110
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-3800
Practice Address - Country:US
Practice Address - Phone:517-346-8026
Practice Address - Fax:517-346-8291
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2010-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010423602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101001365Medicaid
MI101001365Medicaid