Provider Demographics
NPI:1598722654
Name:PARK, ANDREW EUNKOO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:EUNKOO
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17051 DALLAS PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-7109
Mailing Address - Country:US
Mailing Address - Phone:214-370-3535
Mailing Address - Fax:214-370-0004
Practice Address - Street 1:17051 DALLAS PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7109
Practice Address - Country:US
Practice Address - Phone:214-370-3006
Practice Address - Fax:214-828-1379
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6562207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159521701Medicaid
TXP00714233OtherRAIL ROAD MEDICARE PIN
TX8810M3OtherBLUE CROSS PIN
TX159521702Medicaid
TX00954841AMedicaid
TXH62809Medicare UPIN
TX00954841AMedicaid
TX159521702Medicaid