Individual
ANDREA JO GOETHALS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
8235 HOLLY RD, SUITE 1, GRAND BLANC, MI 48439-2441
(810) 694-9700
(810) 694-9940
Mailing address
8235 HOLLY RD, SUITE 1, GRAND BLANC, MI 48439-2441
(810) 694-9700
(810) 694-9940
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
5101015223
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01007313
HEALTH PLUS
MI
01
—
0252511984
BLUE CROSS
MI
01
—
0N89830006
BLUE CROSS MEDICARE ADVAN
MI
05
—
114995665
—
MI
01
—
382626202
AETNA
MI
01
—
46149
HEALTH PLAN OF MICHIGAN
MI
01
—
6U10108
HEALTH ALLIANCE PLAN
MI
Enumeration date
03/06/2007
Last updated
04/29/2009
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