Provider Demographics
NPI:1174657910
Name:OULAI, ANDRE Z (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:Z
Last Name:OULAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 COLUMBUS AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6478
Mailing Address - Country:US
Mailing Address - Phone:989-377-4477
Mailing Address - Fax:989-894-6181
Practice Address - Street 1:4 COLUMBUS AVE STE 160
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6478
Practice Address - Country:US
Practice Address - Phone:989-377-4477
Practice Address - Fax:989-894-6181
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055991A207X00000X
MI4301071554207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200371990Medicaid
IN217230QQQMedicare PIN
IN200371990Medicaid