Provider Demographics
NPI:1942400346
Name:KATYCHEV, ANDREI (MD)
Entity Type:Individual
Prefix:
First Name:ANDREI
Middle Name:
Last Name:KATYCHEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29877 TELEGRAPH RD STE 302
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7660
Mailing Address - Country:US
Mailing Address - Phone:248-796-7466
Mailing Address - Fax:248-450-5580
Practice Address - Street 1:29877 TELEGRAPH RD STE 302
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-796-7466
Practice Address - Fax:248-450-5580
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4301085733OtherLICENSE
MI4301085733OtherLICENSE
MI1942400346Medicaid