Provider Demographics
NPI:1851322515
Name:ANDREWS, MICHAEL C (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 PACKARD AVE
Mailing Address - Street 2:STE 600
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-7118
Mailing Address - Country:US
Mailing Address - Phone:530-741-6245
Mailing Address - Fax:530-741-9274
Practice Address - Street 1:5730 PACKARD AVE
Practice Address - Street 2:STE 600
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-7118
Practice Address - Country:US
Practice Address - Phone:530-741-6245
Practice Address - Fax:530-741-9274
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1167213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E11670Medicaid
CA000E11671Medicare ID - Type Unspecified
CA000E11670Medicaid