Basic Information
| Provider Information | |||||||||
| NPI: | 1588624076 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAXE | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 804 SERVICE RD # A201 | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488247015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178842976 | ||||||||
| FaxNumber: | 5174323928 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 E MICHIGAN AVE | ||||||||
| Address2: | STE 655 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489121800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172672460 | ||||||||
| FaxNumber: | 5172672462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 08/12/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 4301029389 | MI | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 253087 | 01 | MI | HEALTH ADVANTAGE | OTHER | 4219191 | 05 | MI | MEDICAID | 0987747 | 01 | MI | HEALTH PLUS | OTHER | 253087 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 0202511451 | 01 | MI | BLUE CROSS BLUE SHIELD MI | OTHER | 020B560300 | 01 | MI | BLUE CROSS BLUE SHIELD MI | OTHER | 4273740 | 05 | MI | MEDICAID | A35251 | 01 | MI | HEALTH NET FEDERAL SERVIC | OTHER | 020B560300 | 01 | MI | COMMUNITY BLUE | OTHER | 1588624076 | 05 | MI | MEDICAID | 4718182 | 05 | MI | MEDICAID | C7383 | 01 | MI | MCARE | OTHER | A35251 | 01 | MI | HAP | OTHER | OB560300 | 01 | MI | BLUE CARE NETWORK | OTHER | 020B560300 | 01 | MI | BLUE CHOICE | OTHER |