Provider Demographics
NPI:1780650101
Name:ZALESKI, ANDREW CZESLAW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:CZESLAW
Last Name:ZALESKI
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 1:2401 UPPAKRIK LANE
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275
Mailing Address - Country:US
Mailing Address - Phone:941-412-1613
Mailing Address - Fax:941-412-1613
Practice Address - Street 1:2401 UPPAKRIK LN
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-1755
Practice Address - Country:US
Practice Address - Phone:941-412-1613
Practice Address - Fax:941-412-1613
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-25
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 84809204C00000X
VA0101030715204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269472700Medicaid
VAP00768151OtherRR MEDICARE VA
FL269472700Medicaid
VAP00768151OtherRR MEDICARE VA