Provider Demographics
NPI:1689624017
Name:LIVINGSTON, ANDREW J (MD FACS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:MD FACS
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Other - First Name:
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Mailing Address - Street 1:2060 EAST PARIS AVE SE
Mailing Address - Street 2:#110
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-464-4665
Mailing Address - Fax:616-957-1845
Practice Address - Street 1:2060 EAST PARIS AVE SE
Practice Address - Street 2:#110
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-464-4665
Practice Address - Fax:616-957-1845
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2013-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010617512086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4694901Medicaid
MIOD16253014Medicare ID - Type Unspecified
MI4694901Medicaid