Provider Demographics
NPI:1235249392
Name:ANDOLSEK, WILLIAM C (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:ANDOLSEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1575 N EAST EXPY NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2317
Mailing Address - Country:US
Mailing Address - Phone:404-785-1258
Mailing Address - Fax:
Practice Address - Street 1:1575 N EAST EXPY NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2317
Practice Address - Country:US
Practice Address - Phone:404-785-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5522135-12042085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1600683OtherUNITED HEALTHCARE
UT76374OtherPUBLIC EMPLOYEES HEALTH
UT35834OtherDESERET MUTUAL
UT8550895OtherAETNA
UTQM0000027099OtherALTIUS
UT35524OtherUUHN
UT870355724ANDOtherEDUCATORS MUTUAL
UT107027526101OtherSELECTHEALTH
UT55221351200001OtherBLUE SHIELD
UT8550895OtherAETNA
UT870355724ANDOtherEDUCATORS MUTUAL