Provider Demographics
NPI:1568452902
Name:SELUZHITSKIY, ANDREY P (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREY
Middle Name:P
Last Name:SELUZHITSKIY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8984 E US HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:NEW CARLISLE
Mailing Address - State:IN
Mailing Address - Zip Code:46552-9038
Mailing Address - Country:US
Mailing Address - Phone:574-654-8490
Mailing Address - Fax:574-654-3643
Practice Address - Street 1:8984 E US HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:46552-9038
Practice Address - Country:US
Practice Address - Phone:574-654-8490
Practice Address - Fax:574-654-3643
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059665A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200528000Medicaid
INH83101Medicare UPIN
IN146470G4Medicare PIN