Basic Information
| Provider Information | |||||||||
| NPI: | 1093725764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAYLOR | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 416 CONNABLE AVE | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497702212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314877129 | ||||||||
| FaxNumber: | 2314873082 | ||||||||
| Practice Location | |||||||||
| Address1: | 416 CONNABLE AVE | ||||||||
| Address2: | ACUTE REHABILITATION UNIT | ||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497702212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314873496 | ||||||||
| FaxNumber: | 2314873424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 10/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 077046 | MI | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 0B41120 | 01 | MI | BCBSM | OTHER |