Provider Demographics
NPI:1407839996
Name:OZOLINS, ANDIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDIS
Middle Name:E
Last Name:OZOLINS
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 1:22250 PROVIDENCE DR
Mailing Address - Street 2:STE 705
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-552-9858
Mailing Address - Fax:248-552-9510
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:STE 705
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-552-9858
Practice Address - Fax:248-552-9510
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029481207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4169901Medicaid
MIOF360210OtherMEDICARE ID TYPE UNSPECIFIED
MI4169901Medicaid
OF37283Medicare ID - Type Unspecified