Basic Information
| Provider Information | |||||||||
| NPI: | 1750377206 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRUITT | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5325 ELLIOTT DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481978633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347125500 | ||||||||
| FaxNumber: | 7347128209 | ||||||||
| Practice Location | |||||||||
| Address1: | 5325 ELLIOTT DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481978633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347125500 | ||||||||
| FaxNumber: | 7347128209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 12/31/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | AP070330 | MI | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
No ID Information.