Provider Demographics
NPI:1679957526
Name:HUANG, ANDREW JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JONATHAN
Last Name:HUANG
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 1:1708 MARQUARDT RD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4311
Mailing Address - Country:US
Mailing Address - Phone:949-303-8679
Mailing Address - Fax:
Practice Address - Street 1:215 N 28TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4100
Practice Address - Country:US
Practice Address - Phone:715-847-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1445412085R0001X
WI71451-202085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology