1750306742 NPI number — DR. ANDREW M STARICCO M.D.

Table of content: SIDNEY ALEXANDRIA GEORGE (NPI 1114449980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750306742 NPI number — DR. ANDREW M STARICCO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STARICCO
Provider First Name:
ANDREW
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
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:
1750306742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50505 SCHOENHERR RD STE 290
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48315-3141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-314-0080
Provider Business Mailing Address Fax Number:
877-673-3562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21000 E 12 MILE RD STE 112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CLAIR SHORES
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48081-1156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-314-0080
Provider Business Practice Location Address Fax Number:
877-673-3562
Provider Enumeration Date:
07/12/2006

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: 207RP1001X , with the licence number:  4301054487 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 4301054487 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: AS054487 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 290010212 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 290F349720 . This is a "BLUE CROSS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0E00425 . This is a "BLUE CROSS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3371675 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: CE4301 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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