Healthcare Provider Details

I. General information

NPI: 1588511885
Provider Name (Legal Business Name): MATTHEW ANDREW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 W UTOPIA RD
GLENDALE AZ
85308-5251
US

IV. Provider business mailing address

4485 MOBILE DR
COLUMBUS OH
43220-3712
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: