Provider Demographics
NPI:1760427686
Name:WASKIEL, ANDRZEJ S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRZEJ
Middle Name:S
Last Name:WASKIEL
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 1:10315 DAWSONS CREEK BLVD STE AB
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1912
Mailing Address - Country:US
Mailing Address - Phone:260-442-3502
Mailing Address - Fax:260-442-3598
Practice Address - Street 1:10315 DAWSONS CREEK BLVD STE AB
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1912
Practice Address - Country:US
Practice Address - Phone:260-442-3502
Practice Address - Fax:260-442-3598
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073446A207L00000X
IL036095958208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095958Medicaid
ILL84445Medicare ID - Type Unspecified
ILG46310Medicare UPIN