Basic Information
| Provider Information | |||||||||
| NPI: | 1730180530 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCANDREW | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593445555 | ||||||||
| FaxNumber: | 8593445552 | ||||||||
| Practice Location | |||||||||
| Address1: | 368 BIELBY RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470252774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125375772 | ||||||||
| FaxNumber: | 8125373936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35075385M | OH | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 01044092A | IN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5349807001 | 01 | CIGNA | OTHER | 000000031317 | 01 | ANTHEM | OTHER | 200064060A | 05 | IN | MEDICAID | 1701543 | 01 | UNITED HEALTHCARE | OTHER | N44092 | 01 | HUMANA CHOICE CARE | OTHER | 0657518 | 01 | AETNA | OTHER | 116308 | 01 | IN | ANTHEM MEDICAID MCO | OTHER |