Doctor Name: | DR. ANDREW LOUIS HOMER |
NPI Number: | 1922125178 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 4301088045 |
Business Practice Address: | 400 S 43rd St Renton, WA - 980555714 |
Business Phone Number: | 4252283440 |
Business Fax Number: | |
Mailing Address: | 25246 Network Pl, CHICAGO |
State: | IL |
Postal Code: | 606731252 |
Phone Number: | 4256564255 |
Fax Number: | |
NPI Enumeration Date: | 03/23/2007 |
NPI Last Update Date: | 03/21/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 4301088045 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |