Individual
ANDREW DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
37605 PEMBROKE AVE, LIVONIA, MI 48152-1050
(734) 591-7931
(734) 464-0335
Mailing address
620 JOHN PAUL JONES CIR, NAVAL MEDICAL CENTER PORTSMOUTH, PORTSMOUTH, VA 23708-2111
(757) 953-0669
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301506177
MI
208D00000X
General Practice Physician
0101258945
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538583703
—
MI
Enumeration date
02/09/2014
Last updated
10/24/2022
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