Provider Demographics
NPI:1508961384
Name:KLEAVELAND, ANDREW COVINGTON (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:COVINGTON
Last Name:KLEAVELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-727-4444
Mailing Address - Fax:231-728-4789
Practice Address - Street 1:1560 E SHERMAN BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1867
Practice Address - Country:US
Practice Address - Phone:231-672-8145
Practice Address - Fax:231-672-8111
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301048293207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI29 061 0824 1OtherBLUE CROSS BLUE SHIELD
MI1653718Medicaid
MI4301048293OtherSTATE LICENSE NUMBER
MI1653718Medicaid
MI29 061 0824 1OtherBLUE CROSS BLUE SHIELD