Provider Demographics
NPI:1760576342
Name:GASECKI, ANDREW P (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
Last Name:GASECKI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 E HIGH RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4859
Mailing Address - Country:US
Mailing Address - Phone:801-446-8156
Mailing Address - Fax:801-446-8393
Practice Address - Street 1:8706 S 700 E
Practice Address - Street 2:SUITE 200
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1807
Practice Address - Country:US
Practice Address - Phone:801-446-8156
Practice Address - Fax:801-446-8393
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT36260312052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF86992Medicare UPIN