Provider Demographics
NPI:1447364773
Name:ANDRESHAK, THOMAS GUIDO (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:GUIDO
Last Name:ANDRESHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 KINGS POINTE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1500
Mailing Address - Country:US
Mailing Address - Phone:419-517-7500
Mailing Address - Fax:419-517-7501
Practice Address - Street 1:7640 SYLVANIA AVE
Practice Address - Street 2:STE. B
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9729
Practice Address - Country:US
Practice Address - Phone:419-517-7500
Practice Address - Fax:419-517-7501
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062765A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0920070Medicaid
MI104409641Medicaid
OH0920070Medicaid
F29052Medicare UPIN