Provider Demographics
NPI:1942236500
Name:ANDRECA, STELIAN N (MD)
Entity Type:Individual
Prefix:
First Name:STELIAN
Middle Name:N
Last Name:ANDRECA
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 110
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67749-0110
Mailing Address - Country:US
Mailing Address - Phone:785-475-2221
Mailing Address - Fax:785-475-3847
Practice Address - Street 1:902 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:KS
Practice Address - Zip Code:67749-2412
Practice Address - Country:US
Practice Address - Phone:785-475-2221
Practice Address - Fax:785-475-3847
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200347210AMedicaid
KS105067Medicare ID - Type UnspecifiedMC
KS200347210AMedicaid