Provider Demographics
NPI:1578568697
Name:VENDITTI, ANDREW FRANK (PAC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:FRANK
Last Name:VENDITTI
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1642
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-0043
Mailing Address - Country:US
Mailing Address - Phone:812-758-4199
Mailing Address - Fax:270-688-1781
Practice Address - Street 1:4133 GATEWAY BLVD STE 170
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8950
Practice Address - Country:US
Practice Address - Phone:812-758-4199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA673363AS0400X
IN10000519A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000205439OtherANTHEM BLUE CROSS
KY970020561Medicare PIN
KY0649911Medicare PIN
S37573Medicare UPIN
INP00009890Medicare PIN
IN202280GMedicare PIN