Provider Demographics
NPI:1275224065
Name:MOORE, ANDREW WILLIAM JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WILLIAM JAMES
Last Name:MOORE
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:28050 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5919
Mailing Address - Country:US
Mailing Address - Phone:947-521-7386
Mailing Address - Fax:
Practice Address - Street 1:28100 GRAND RIVER AVE STE 313
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5970
Practice Address - Country:US
Practice Address - Phone:947-521-7150
Practice Address - Fax:248-426-2473
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5151016294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine