Healthcare Provider Details

I. General information

NPI: 1528048477
Provider Name (Legal Business Name): LOUIS ANDARY JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23050 WEST RD STE 210
BROWNSTOWN TWP MI
48183-1472
US

IV. Provider business mailing address

1640 FORT ST SUITE D ATTN DENISE
TRENTON MI
48183-2040
US

V. Phone/Fax

Practice location:
  • Phone: 734-282-7000
  • Fax:
Mailing address:
  • Phone: 734-391-3057
  • Fax: 734-391-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301043773
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: