Provider Demographics
NPI:1164238846
Name:YOUNG, ANDREW RUSSELL
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RUSSELL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2973 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9310
Mailing Address - Country:US
Mailing Address - Phone:317-441-1407
Mailing Address - Fax:
Practice Address - Street 1:2973 KINGS CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9310
Practice Address - Country:US
Practice Address - Phone:317-441-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program