Provider Demographics
NPI:1871682088
Name:IWACH, ANDREW GEORGE (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:GEORGE
Last Name:IWACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:55 STEVENSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-2936
Mailing Address - Country:US
Mailing Address - Phone:415-981-2020
Mailing Address - Fax:415-981-2019
Practice Address - Street 1:55 STEVENSON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-2936
Practice Address - Country:US
Practice Address - Phone:415-981-2020
Practice Address - Fax:415-981-2019
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56142207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G561421Medicaid
CA00G561421Medicaid
CAE88882Medicare UPIN