MEDICARE: ANDOVER PARTNERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1396185898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDOVER PARTNERS LLC

Provider Business Mailing Address
First Line	:	10214 HUNTINGTON VIEW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-3037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10214 HUNTINGTON VIEW DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-3037
Country	:	US
Telephone Number	:	515-528-5176
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MIRZA N BAIG
Credential	:	MD
Telephone Number	:	515-528-5176

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	06/28/2013

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