Provider Demographics
NPI:1164884318
Name:LU, ANDREW TACHUNG (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:TACHUNG
Last Name:LU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 LEAHY ST
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5500
Mailing Address - Country:US
Mailing Address - Phone:231-672-7800
Mailing Address - Fax:231-672-7801
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:SUITE 201A
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-672-7800
Practice Address - Fax:231-672-7801
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A17419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program