1730180530 NPI number — MICHAEL E MCANDREW M.D.

Table of content: MICHAEL E MCANDREW M.D. (NPI 1730180530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730180530 NPI number — MICHAEL E MCANDREW M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCANDREW
Provider First Name:
MICHAEL
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730180530
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 635283
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-5283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-344-5555
Provider Business Mailing Address Fax Number:
859-344-5552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
368 BIELBY RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47025-2774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-537-5772
Provider Business Practice Location Address Fax Number:
812-537-3936
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  35075385M , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 01044092A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5349807001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000031317 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200064060A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1701543 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: N44092 . This is a "HUMANA CHOICE CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0657518 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 116308 . This is a "ANTHEM MEDICAID MCO" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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