Provider Demographics
NPI:1982857512
Name:ANDREW J. HAYDUKE, M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ANDREW J. HAYDUKE, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAYDUKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-341-6996
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:KIEWIT SUITE 206
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-341-6996
Mailing Address - Fax:760-341-6776
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:KIEWIT SUITE 206
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-341-6996
Practice Address - Fax:760-341-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70532208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty