Provider Demographics
NPI:1265116958
Name:ANDREW, IAN ARTHUR PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:ARTHUR PATRICK
Last Name:ANDREW
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 1:7575 GRAND RIVER
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114
Mailing Address - Country:US
Mailing Address - Phone:810-844-7950
Mailing Address - Fax:
Practice Address - Street 1:7575 GRAND RIVER
Practice Address - Street 2:SUITE 209
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114
Practice Address - Country:US
Practice Address - Phone:810-844-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2024-02-08
Deactivation Date:2024-01-17
Deactivation Code:
Reactivation Date:2024-02-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program