Andrew Atisha, DMD
Dentist in Detroit, MI. Individual provider (NPI-1).
NPI number1932581998
StatusActive
Last updated in NPPESApr 26, 2016
Details
- NPI
- 1932581998
- Entity type
- Individual (NPI-1)
- Name
- Andrew Atisha
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 25, 2015
- Last updated
- Apr 26, 2016
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · ORDER AND REFERRING ONLY - DENTIST
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 5315071893 | MI | Yes |
Practice location
2700 Martin Luther King Jr BlvdDetroit, MI 48208-2576
Phone 313-494-6700
Mailing address
2700 Martin Luther King Jr BlvdDetroit, MI 48208-2576
Phone 313-494-6700
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