Provider Demographics
NPI:1508327792
Name:PISCHEK, ANDREW MARCO
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MARCO
Last Name:PISCHEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21400 STATE HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567
Mailing Address - Country:US
Mailing Address - Phone:251-947-5811
Mailing Address - Fax:251-945-1057
Practice Address - Street 1:21400 STATE HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567
Practice Address - Country:US
Practice Address - Phone:251-947-5811
Practice Address - Fax:251-945-1057
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist