Provider Demographics
NPI:1023214475
Name:INDRESANO, ANDREW ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALBERT
Last Name:INDRESANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3160 N TARRANT PKWY STE 404
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8614
Mailing Address - Country:US
Mailing Address - Phone:817-205-2939
Mailing Address - Fax:817-887-3015
Practice Address - Street 1:3160 N TARRANT PKWY STE 404
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8614
Practice Address - Country:US
Practice Address - Phone:817-205-2939
Practice Address - Fax:817-887-3015
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0940207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX368679YZRSMedicare PIN