Healthcare Provider Details

I. General information

NPI: 1932722428
Provider Name (Legal Business Name): ANDREW YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 STEWART RD
MONROE MI
48162-4222
US

IV. Provider business mailing address

55 COLE RD
MONROE MI
48162-4103
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-8430
  • Fax:
Mailing address:
  • Phone: 734-242-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301100848
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: