Healthcare Provider Details

I. General information

NPI: 1720286115
Provider Name (Legal Business Name): ANGELIQUE A ANDREWS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELIQUE A JOHNSON

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 3RD AVE SE
CEDAR RAPIDS IA
52403-4009
US

IV. Provider business mailing address

1225 3RD AVE SE
CEDAR RAPIDS IA
52403-4009
US

V. Phone/Fax

Practice location:
  • Phone: 319-730-7300
  • Fax: 256-585-6713
Mailing address:
  • Phone: 319-730-7300
  • Fax: 256-585-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD27938
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier118769
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier9750064
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerAETNA
# 3
Identifier051541835
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: