Healthcare Provider Details

I. General information

NPI: 1952345910
Provider Name (Legal Business Name): MICHAEL THOMAS ANDARY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE STE 520
LANSING MI
48912-1899
US

IV. Provider business mailing address

804 SERVICE RD STE A109B
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5260
  • Fax: 517-364-5251
Mailing address:
  • Phone: 517-353-4911
  • Fax: 517-432-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301403972
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: