Provider Demographics
NPI:1457046005
Name:ROTHSTEIN- COSTRIS, ANDREEA (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREEA
Middle Name:
Last Name:ROTHSTEIN- COSTRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREEA
Other - Middle Name:
Other - Last Name:ROTHSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:27131 DELTON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3346
Mailing Address - Country:US
Mailing Address - Phone:248-720-9288
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4351051350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program