Provider Demographics
NPI:1659994572
Name:MWANGI, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MWANGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 COMMERCE DR STE 15A
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-1547
Mailing Address - Country:US
Mailing Address - Phone:574-339-7768
Mailing Address - Fax:574-383-6767
Practice Address - Street 1:1657 COMMERCE DR STE 15A
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-1547
Practice Address - Country:US
Practice Address - Phone:574-339-7768
Practice Address - Fax:574-383-6767
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300036738Medicaid