Provider Demographics
NPI:1952345910
Name:ANDARY, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:ANDARY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-4911
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:1200 E MICHIGAN AVE STE 520
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1899
Practice Address - Country:US
Practice Address - Phone:517-364-5260
Practice Address - Fax:517-364-5251
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-06-21
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Provider Licenses
StateLicense IDTaxonomies
MI4301403972208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1916908Medicaid
MI1916908Medicaid
MIOC36082030Medicare PIN
MIA06345Medicare UPIN