Provider Demographics
NPI:1750306742
Name:STARICCO, ANDREW M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:STARICCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50505 SCHOENHERR RD STE 290
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3141
Mailing Address - Country:US
Mailing Address - Phone:586-314-0080
Mailing Address - Fax:586-731-6257
Practice Address - Street 1:21000 E 12 MILE RD STE 112
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1156
Practice Address - Country:US
Practice Address - Phone:586-772-5550
Practice Address - Fax:586-772-2470
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054487207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E00425OtherBLUE CROSS OF MICHIGAN
MI290F349720OtherBLUE CROSS OF MICHIGAN
MI290010212OtherRAILROAD MEDICARE
MI3371675Medicaid
MIAS054487OtherSTATE LICENSE NUMBER
MICE4301OtherRAILROAD MEDICARE GROUP
MICE4301OtherRAILROAD MEDICARE GROUP
MIG06138Medicare UPIN
MI0F34972009Medicare PIN