Provider Demographics
NPI:1265964357
Name:MESCHKE, ANDREW (MS, AT, ATC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MESCHKE
Suffix:
Gender:M
Credentials:MS, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E PORTER ST
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1831
Mailing Address - Country:US
Mailing Address - Phone:517-629-0590
Mailing Address - Fax:517-629-0657
Practice Address - Street 1:611 E PORTER ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1831
Practice Address - Country:US
Practice Address - Phone:517-629-0590
Practice Address - Fax:517-629-0657
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010012572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer