Provider Demographics
NPI:1932321635
Name:ROSSI, ANDREA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIE
Last Name:ROSSI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:HACKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3950 S ROCHESTER RD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5160
Mailing Address - Country:US
Mailing Address - Phone:248-299-0000
Mailing Address - Fax:248-299-6885
Practice Address - Street 1:3950 S ROCHESTER RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5160
Practice Address - Country:US
Practice Address - Phone:248-299-0000
Practice Address - Fax:248-299-6885
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010160712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H217350OtherBCBSM GROUP
MI1356319395OtherBCBSM INDIVIDUAL
MI1932321635Medicaid
MI1932321635Medicaid