Healthcare Provider Details

I. General information

NPI: 1821064601
Provider Name (Legal Business Name): ANDREA LOUISE CARLIN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA LOUISE BYFORD P.A.

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 E. CHICAGO RD
STURGIS MI
49091
US

IV. Provider business mailing address

1717 E. CHICAGO RD
STURGIS MI
49091
US

V. Phone/Fax

Practice location:
  • Phone: 269-651-3554
  • Fax: 269-659-4998
Mailing address:
  • Phone: 269-651-3554
  • Fax: 269-659-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003893
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: