Provider Demographics
NPI:1336934371
Name:HARE, ANDREW HARE
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:HARE
Last Name:HARE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5355 HIGHLAND RD APT 228
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1955
Mailing Address - Country:US
Mailing Address - Phone:248-730-5608
Mailing Address - Fax:
Practice Address - Street 1:5355 HIGHLAND RD APT 228
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1955
Practice Address - Country:US
Practice Address - Phone:248-730-5608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH600067738497172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker