Provider Demographics
NPI:1710101688
Name:HARDY, ANDREW JR (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:HARDY
Suffix:JR
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 1:22100 GREENFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237
Mailing Address - Country:US
Mailing Address - Phone:248-460-3077
Mailing Address - Fax:248-355-4580
Practice Address - Street 1:22100 GREENFIELD ROAD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237
Practice Address - Country:US
Practice Address - Phone:248-460-3077
Practice Address - Fax:248-355-4580
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046774207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A73915Medicare UPIN