Provider Demographics
NPI:1235124629
Name:ELLOWITZ, ANDREW S (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:S
Last Name:ELLOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4020 S 57TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4302
Mailing Address - Country:US
Mailing Address - Phone:561-432-5035
Mailing Address - Fax:877-714-5190
Practice Address - Street 1:4101 NW 4TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2850
Practice Address - Country:US
Practice Address - Phone:954-583-8130
Practice Address - Fax:954-583-8956
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2012-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME72589207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254410500Medicaid
FLP00005660Medicare PIN
FLG51848Medicare UPIN
FL42325YMedicare PIN
FL5654620001Medicare PIN