Provider Demographics
NPI:1235323072
Name:HEAD, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:HEAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1155 EAST PARIS AVE SE
Mailing Address - Street 2:STE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8368
Mailing Address - Country:US
Mailing Address - Phone:616-459-8088
Mailing Address - Fax:616-459-8312
Practice Address - Street 1:1155 E PARIS AVE SE
Practice Address - Street 2:STE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8368
Practice Address - Country:US
Practice Address - Phone:616-459-8088
Practice Address - Fax:616-459-8312
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2021-06-30
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Provider Licenses
StateLicense IDTaxonomies
MI4301083216207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH31122Medicare UPIN
MION16600004Medicare PIN