Provider Demographics
NPI:1265690697
Name:EMMERMAN, ANDREW B (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:EMMERMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:729 E SPAULDING AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-3512
Mailing Address - Country:US
Mailing Address - Phone:719-547-9119
Mailing Address - Fax:
Practice Address - Street 1:729 E SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007
Practice Address - Country:US
Practice Address - Phone:719-547-9119
Practice Address - Fax:719-547-7555
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI448207R00000X
CODR.0052069207R00000X
IL336.087795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine