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NPI Code Detail

MEDICARE: ANDOLA C MATHIS MD PC

MEDICARE: ANDOLA C MATHIS MD PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician

General Provider Information

NPI Number : 1992711402
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANDOLA C MATHIS MD PC
Provider Business Mailing Address
First Line : 21 MICHIGAN ST NE
Second Line : SUITE 660
City : GRAND RAPIDS
State : MI
Zip : 49503-2528
Country : US
Telephone Number : 616-451-2993
Fax Number : 616-451-4393
Provider Business Practice Location Address
First Line : 21 MICHIGAN ST NE
Second Line : SUITE 660
City : GRAND RAPIDS
State : MI
Zip : 49503-2528
Country : US
Telephone Number : 616-451-2993
Fax Number : 616-451-4393
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : ANDOLA CHAMBERLAIN MATHIS
Credential : M.D.
Telephone Number : 616-451-2993
Provider Enumeration Date : 08/01/2006
Last Update Date : 08/10/2007

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