Organization
LOURDES V ANDAYA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOURDES V ANDAYA MD (PRESIDENT)
(313) 832-2880
Entity
Organization
Contact information
Practice address
7 CAMERON PL, GROSSE POINTE, MI 48230-1912
(313) 832-2880
(313) 832-2880
Mailing address
4160 JOHN R ST, SUITE 819, DETROIT, MI 48201-2020
(313) 832-2880
(313) 832-7845
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
4301032565
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1783024-10
—
MI
01
—
OH23713
BLUE SHIELD
—
Enumeration date
05/16/2007
Last updated
08/23/2010
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