Provider Demographics
NPI:1982073524
Name:KOLONGOWSKI, ANDREA MARIE
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:KOLONGOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:DOTTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:22255 GREENFIELD RD STE 500
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3734
Mailing Address - Country:US
Mailing Address - Phone:248-849-3186
Mailing Address - Fax:248-849-3460
Practice Address - Street 1:22255 GREENFIELD RD STE 500
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3734
Practice Address - Country:US
Practice Address - Phone:248-849-3186
Practice Address - Fax:248-849-3460
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant