Provider Demographics
NPI:1376741546
Name:ANDREOZZI, MICHAEL K (HIS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:ANDREOZZI
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 TIPPING ROCK DR
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1078
Mailing Address - Country:US
Mailing Address - Phone:401-921-3320
Mailing Address - Fax:
Practice Address - Street 1:15 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5530
Practice Address - Country:US
Practice Address - Phone:508-761-8015
Practice Address - Fax:508-399-6414
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1543130Medicaid