Basic Information
| Provider Information | |||||||||
| NPI: | 1669421145 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDEA | ||||||||
| FirstName: | ALEODOR | ||||||||
| MiddleName: | ALEXANDRU | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3621 S STATE ST | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481081633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346475299 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 E MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349364000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 03/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | 4301074949 | MI | N | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207ZP0007X | 4301074949 | MI | N | Allopathic & Osteopathic Physicians | Pathology | Molecular Genetic Pathology | 207ZP0102X | 4301074949 | MI | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 009936903 | 05 | AL | MEDICAID | 051534581 | 01 | AL | BCBS | OTHER | 009936902 | 05 | AL | MEDICAID | 009937603 | 05 | AL | MEDICAID | 051535431 | 01 | AL | BCBS | OTHER | 051534579 | 01 | AL | BCBS | OTHER |