Healthcare Provider Details

I. General information

NPI: 1225057409
Provider Name (Legal Business Name): ANDRIA KEUSCH P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LINDEN ST SUITE 1
BIG RAPIDS MI
49307-1879
US

IV. Provider business mailing address

650 LINDEN ST SUITE 1
BIG RAPIDS MI
49307-1879
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-3200
  • Fax: 231-796-5562
Mailing address:
  • Phone: 231-796-3200
  • Fax: 231-796-5562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003219
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: