Provider Demographics
NPI:1093723413
Name:ANDALEON, DAISY (MD)
Entity type:Individual
Prefix:DR
First Name:DAISY
Middle Name:
Last Name:ANDALEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10256 OLD GREEN BAY RD FL 3
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-2814
Mailing Address - Country:US
Mailing Address - Phone:262-551-4270
Mailing Address - Fax:262-551-4275
Practice Address - Street 1:10256 OLD GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-2814
Practice Address - Country:US
Practice Address - Phone:262-551-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36091220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04923008OtherBLUE CROSS BLUE SHIELD
ILF94385OtherUPIN
WIK401239436OtherMEDICARE