Basic Information
| Provider Information | |||||||||
| NPI: | 1174515456 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOWY | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14001 N 7TH ST STE A101 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850224382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029423966 | ||||||||
| FaxNumber: | 6025489470 | ||||||||
| Practice Location | |||||||||
| Address1: | 10214 N TATUM BLVD STE B300 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850284233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029540777 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2005 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | POD-000220 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213E00000X | 0220 | AZ | N | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | AZ0194250 | 01 | AZ | BCBS | OTHER | 700387 | 05 | AZ | MEDICAID |