Provider Demographics
NPI:1760428452
Name:ANDYA, MICHAEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:ANDYA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:101 MARGARET LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-4207
Mailing Address - Country:US
Mailing Address - Phone:530-273-2221
Mailing Address - Fax:530-273-3550
Practice Address - Street 1:101 MARGARET LN
Practice Address - Street 2:SUITE A
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4207
Practice Address - Country:US
Practice Address - Phone:530-273-2221
Practice Address - Fax:530-273-3550
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG69223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF21968Medicare UPIN
CA00G692230Medicare ID - Type Unspecified