Provider Demographics
NPI:1427375450
Name:SCHWOERER, ANDREA MARIA ZELISKO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARIA ZELISKO
Last Name:SCHWOERER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:MARIA
Other - Last Name:ZELISKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12266 DEPAUL DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-344-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17378208600000X
NC2016-01399208600000X
MO2019009603208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1427375450Medicaid
SCNC2906Medicaid
NCNCU153CMedicare PIN
NC1427375450Medicaid