Healthcare Provider Details

I. General information

NPI: 1659926129
Provider Name (Legal Business Name): ANDREW MICHAEL CUELLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date: 06/22/2026
Reactivation Date: 08/05/2026

III. Provider practice location address

33155 ANNAPOLIS ST
WAYNE MI
48184-2405
US

IV. Provider business mailing address

33155 ANNAPOLIS ST
WAYNE MI
48184-2405
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-4000
  • Fax: 734-467-4017
Mailing address:
  • Phone: 734-467-4000
  • Fax: 734-467-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5951001620
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: