Provider Demographics
NPI:1467456954
Name:NOLEWAJKA, ANDRE J (MD; MCLSC)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:J
Last Name:NOLEWAJKA
Suffix:
Gender:M
Credentials:MD; MCLSC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 10570
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0570
Mailing Address - Country:US
Mailing Address - Phone:479-314-4650
Mailing Address - Fax:479-452-9459
Practice Address - Street 1:7001 ROGERS AVE
Practice Address - Street 2:STE 401
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4073
Practice Address - Country:US
Practice Address - Phone:479-314-4650
Practice Address - Fax:479-452-9459
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2997207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105850001Medicaid
A002OtherTRICARE
60014634OtherTRAVELERS M/C R/R
OK100078200AMedicaid
119173OtherDEPT OF LABOR
14059000040OtherQUALCHOICE
29730300OtherBLACK LUNG
29730300OtherUMWA M/C
53875OtherMEDICARE, ARK BC, FED BC
53875OtherMEDICARE, ARK BC, FED BC
29730300OtherUMWA M/C