Provider Demographics
NPI:1689605545
Name:WESELY, ANDREW C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:WESELY
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 1:5920 COUR SAINT MICHELLE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-4315
Mailing Address - Country:US
Mailing Address - Phone:775-771-4749
Mailing Address - Fax:
Practice Address - Street 1:605 SIERRA ROSE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2060
Practice Address - Country:US
Practice Address - Phone:775-689-5410
Practice Address - Fax:775-689-5431
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7129174400000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC9383OtherBLUE CROSS BLUE SHIELD
NV050057655OtherRAILROAD MEDICARE
NV2016530Medicaid
NV30037Medicare ID - Type Unspecified
NVCC9383OtherBLUE CROSS BLUE SHIELD