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NPI Code Detail

MEDICARE: ANDOLA CHAMBERLAIN MATHIS M.D.

MEDICARE: ANDOLA CHAMBERLAIN MATHIS M.D.
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
1207V00000XObstetrics & Gynecology Physician4301074425MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11604113602OTHERMIBCBSM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417994997
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDOLA CHAMBERLAIN MATHIS M.D.
Provider Business Mailing Address
First Line : 21 MICHIGAN ST NE
Second Line : SUITE 660
City : GRAND RAPIDS
State : MI
Zip : 49503-2528
Country : US
Telephone Number : 616-451-2993
Fax Number : 616-451-4393
Provider Business Practice Location Address
First Line : 21 MICHIGAN ST NE
Second Line : SUITE 660
City : GRAND RAPIDS
State : MI
Zip : 49503-2528
Country : US
Telephone Number : 616-451-2993
Fax Number : 616-451-4393
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2006
Last Update Date : 08/10/2007

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