Provider Demographics
NPI:1639135445
Name:ISHAK, ANDRE MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:MICHAEL
Last Name:ISHAK
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 1:5720 RALSTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7844
Mailing Address - Country:US
Mailing Address - Phone:805-804-4168
Mailing Address - Fax:805-830-1177
Practice Address - Street 1:2221 WANKEL WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0192
Practice Address - Country:US
Practice Address - Phone:805-988-9366
Practice Address - Fax:805-483-3747
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG813162086S0105X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG81316OtherSTATE LICENSE
CAG81316OtherSTATE LICENSE
CAWG81316AMedicare PIN
CA0878110001Medicare NSC
CAW268Medicare ID - Type Unspecified
CAWG81316HMedicare PIN
CAW268AMedicare PIN