Provider Demographics
NPI:1003979931
Name:HEWCHUCK, ANDREW (DPM)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:HEWCHUCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W LINE ST
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-3413
Mailing Address - Country:US
Mailing Address - Phone:760-872-1636
Mailing Address - Fax:
Practice Address - Street 1:310 W LINE ST
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3413
Practice Address - Country:US
Practice Address - Phone:760-872-1636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3878213E00000X
NV9503213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0738750001OtherDMERC MEDICARE
CA000E38780Medicaid
CA480014561OtherRAILROAD MEDICARE
CAU42983Medicare UPIN
CA000E38780Medicare ID - Type Unspecified