Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101012343 | MI |
NPI | 1386692218 |
---|---|
Provider Name | Mr. Andrew Edgar Mendians |
First Address | Manistee, MI 49660-9364 |
Second Address | Manistee, MI 49660-9364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 13/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0M88350002 | (02) | MI |
4131646 | (05) | MI |
G64832 | (02) | MI |