Healthcare Provider Details

I. General information

NPI: 1720295280
Provider Name (Legal Business Name): LOURDES V ANDAYA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CAMERON PL
GROSSE POINTE MI
48230-1912
US

IV. Provider business mailing address

4160 JOHN R ST SUITE 819
DETROIT MI
48201-2020
US

V. Phone/Fax

Practice location:
  • Phone: 313-832-2880
  • Fax: 313-832-2880
Mailing address:
  • Phone: 313-832-2880
  • Fax: 313-832-7845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301032565
License Number StateMI

VIII. Authorized Official

Name: DR. LOURDES V ANDAYA
Title or Position: PRESIDENT
Credential: MD
Phone: 313-832-2880