Healthcare Provider Details

I. General information

NPI: 1255241980
Provider Name (Legal Business Name): ANDREW ELLIOTT PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 KNOTWOOD DR
HOLT MI
48842-8765
US

IV. Provider business mailing address

2265 KNOTWOOD DR
HOLT MI
48842-8765
US

V. Phone/Fax

Practice location:
  • Phone: 616-635-0687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number530981
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: