Provider Demographics
NPI:1659366870
Name:BELL-WILLIS, ANDREA RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:RENEE
Last Name:BELL-WILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:RENEE
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5971 GOLF CLUB LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-8225
Mailing Address - Country:US
Mailing Address - Phone:513-896-3000
Mailing Address - Fax:513-737-0524
Practice Address - Street 1:5971 GOLF CLUB LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-8225
Practice Address - Country:US
Practice Address - Phone:513-896-3000
Practice Address - Fax:513-737-0524
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.127537207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0150718Medicaid
OHH265330Medicare PIN
TN3848542Medicaid
OHH265330Medicare PIN
TN3848542Medicare PIN
TN3142451OtherBLUECROSS BLUESHIELD