Provider Demographics
NPI:1386692218
Name:MENDIANS, ANDREW EDGAR (DO)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:EDGAR
Last Name:MENDIANS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1806 E PARKDALE AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9364
Mailing Address - Country:US
Mailing Address - Phone:231-398-9536
Mailing Address - Fax:231-398-9541
Practice Address - Street 1:1806 E PARKDALE AVE
Practice Address - Street 2:STE 3
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9364
Practice Address - Country:US
Practice Address - Phone:231-398-9536
Practice Address - Fax:231-398-9541
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012343207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4131646Medicaid
MI4131646Medicaid
MIG64832Medicare UPIN