Provider Demographics
NPI:1235249392
Name:ANDOLSEK, WILLIAM C (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:ANDOLSEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-487-0451
Mailing Address - Fax:801-487-2467
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-487-0451
Practice Address - Fax:801-487-2467
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5522135-12042085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTQM0000027099OtherALTIUS
UT8550895OtherAETNA
UT870355724ANDOtherEDUCATORS MUTUAL
UT107027526101OtherSELECTHEALTH
UT35834OtherDESERET MUTUAL
UT1600683OtherUNITED HEALTHCARE
UT35524OtherUUHN
UT76374OtherPUBLIC EMPLOYEES HEALTH
UT55221351200001OtherBLUE SHIELD
UT8550895OtherAETNA
UT870355724ANDOtherEDUCATORS MUTUAL