Provider Demographics
NPI:1861477903
Name:LODER, ANDREA SLIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:SLIFER
Last Name:LODER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:SLIFER
Other - Last Name:HELMICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:PEDIATRIC DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8203
Mailing Address - Fax:850-862-0977
Practice Address - Street 1:965 S BAILEY AVE STE 2-4
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-6743
Practice Address - Country:US
Practice Address - Phone:269-639-2777
Practice Address - Fax:269-639-2776
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70335208000000X
MI4301116417208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379588800Medicaid
FL28977OtherBCBSFL
G29682Medicare UPIN
FL28977OtherBCBSFL