Provider Demographics
NPI:1922002476
Name:DEAK, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:DEAK
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:PO BOX 632958
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2958
Mailing Address - Country:US
Mailing Address - Phone:513-451-9698
Mailing Address - Fax:513-451-9412
Practice Address - Street 1:3652 WERK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-4900
Practice Address - Country:US
Practice Address - Phone:513-233-4100
Practice Address - Fax:513-751-2267
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-035423207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH100010951OtherRAILROAD MEDICARE
OH0363940Medicaid
OH0363940Medicaid
OHDE0450379Medicare PIN