Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | AW406915 | MI |
Y | 111NI0900X | Internist | AW406915 | MI |
N | 207RA0401X | Internist - Addiction Medicine | 4301406915 | MI |
NPI | 1053334219 |
---|---|
Provider Name | Dr. Andrew Waller |
First Address | Ann Arbor, MI 48105-9484 |
Second Address | Ypsilanti, MI 48197-1011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 17/03/2018 |