Provider Demographics
NPI:1467428599
Name:LUISI, ANDREW J JR (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:LUISI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 MCDONALD RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5934
Mailing Address - Country:US
Mailing Address - Phone:903-595-5514
Mailing Address - Fax:903-262-3715
Practice Address - Street 1:2608 MCDONALD RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5934
Practice Address - Country:US
Practice Address - Phone:903-595-5514
Practice Address - Fax:903-262-3715
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219185207RC0000X
NY219185-1207UN0901X
TXQ1207207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02619643Medicaid
NY000527993001OtherHEALTH NOW
NY00027031501OtherEXCELLUS UNIVERA
NY2112786OtherINDEPENDENT HEALTH
NY02619643Medicaid
NYRB1931Medicare PIN