Healthcare Provider Details

I. General information

NPI: 1225492622
Provider Name (Legal Business Name): SANDREY HOME HEALTH CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4416 BLACKBERRY LN
LANSING MI
48917-1633
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-775-9799
  • Fax:
Mailing address:
  • Phone: 517-676-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301056626
License Number StateMI

VIII. Authorized Official

Name: ANDREY B SMITH
Title or Position: OWNER
Credential: MD
Phone: 517-775-9799