Provider Demographics
NPI:1376631580
Name:WEST, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950266
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0266
Mailing Address - Country:US
Mailing Address - Phone:502-896-6355
Mailing Address - Fax:502-896-9813
Practice Address - Street 1:2811 KLEMPNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-4203
Practice Address - Country:US
Practice Address - Phone:502-896-6355
Practice Address - Fax:502-896-9813
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32374207N00000X, 207ND0900X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2436690000OtherPASSPORT ADVANTAGE
KY4884OtherGROUP MEDICARE
KY64323744-00Medicaid
KY1110678OtherPASSPORT
KY1488402Medicare ID - Type Unspecified
KY64323744-00Medicaid
KYF51943Medicare UPIN