Provider Demographics
NPI:1093120263
Name:FONDELL, ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:FONDELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1416
Mailing Address - Country:US
Mailing Address - Phone:515-241-8923
Mailing Address - Fax:
Practice Address - Street 1:1215 PLEASANT ST STE 600
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1409
Practice Address - Country:US
Practice Address - Phone:515-241-8923
Practice Address - Fax:515-241-8789
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-055192080P0206X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics