Provider Demographics
NPI:1578779831
Name:SIEDLECKI, ANDREW M (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:SIEDLECKI
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:PO BOX 7898
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33734-7898
Mailing Address - Country:US
Mailing Address - Phone:314-243-2143
Mailing Address - Fax:855-583-3781
Practice Address - Street 1:1201 5TH AVE N STE 302
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1425
Practice Address - Country:US
Practice Address - Phone:314-243-2143
Practice Address - Fax:855-583-3781
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009015711207RN0300X
FLME102550207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113449100Medicaid