Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901002523 | MI |
Y | 222Z00000X | Podiatrist | 5901002523 | MI |
N | 213ES0103X | Foot & Ankle Surgery | 5901002523 | MI |
N | 213ES0103X | Foot & Ankle Surgery | AM002523 | MI |
N | 213ES0131X | Foot Surgery | 5901002523 | MI |
NPI | 1093120297 |
---|---|
Provider Name | Andrew Richard Mastay |
First Address | Roseville, MI 48066-6501 |
Second Address | Roseville, MI 48066-6501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 04/11/2021 |