Provider Demographics
NPI:1891774972
Name:VOSBURGH, ANDREW JAMES (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:VOSBURGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:47601 GRAND RIVER AVE STE B230
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1257
Mailing Address - Country:US
Mailing Address - Phone:248-465-4193
Mailing Address - Fax:248-465-4872
Practice Address - Street 1:47601 GRAND RIVER AVE
Practice Address - Street 2:B223
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1233
Practice Address - Country:US
Practice Address - Phone:248-465-4800
Practice Address - Fax:248-465-4872
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301048062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI175659110Medicaid