Active NPI
Andrea Louise Vidusic
- Athletic Trainer
- Brownstown, MI
National Provider Identifier
1598379307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 23694 Andrew Blvd
Brownstown, MI 48134-9318 - Phone
- (734) 775-6585
- NPI assigned
- Aug 31, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
23694 Andrew Blvd
Brownstown, MI 48134-9318
Mailing address
23694 Andrew Blvd
Brownstown, MI 48134-9318
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598832000000",
"number": "1598379307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23694 ANDREW BLVD",
"city": "BROWNSTOWN",
"state": "MI",
"postal_code": "481349318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23694 ANDREW BLVD",
"city": "BROWNSTOWN",
"state": "MI",
"postal_code": "481349318",
"telephone_number": "734-775-6585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDUSIC",
"first_name": "ANDREA",
"middle_name": "LOUISE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-31",
"last_updated": "2020-08-31",
"certification_date": "2020-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brownstown, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.