Provider Demographics
NPI:1548764236
Name:GAILLARDETZ, ANDREW M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:GAILLARDETZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3 SAINT ELIZABETH BLVD STE 4000
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1284
Mailing Address - Country:US
Mailing Address - Phone:618-256-9355
Mailing Address - Fax:618-206-2332
Practice Address - Street 1:3 SAINT ELIZABETH BLVD STE 4000
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1284
Practice Address - Country:US
Practice Address - Phone:618-233-5480
Practice Address - Fax:618-222-4792
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2022-06-03
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Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.155817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program