Provider Demographics
NPI:1770560625
Name:WOLANIN, ANDRE F (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:F
Last Name:WOLANIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:6115 POWERS BLVD
Practice Address - Street 2:STE. 100
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5471
Practice Address - Country:US
Practice Address - Phone:440-842-1570
Practice Address - Fax:440-842-8230
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067748W207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0222173Medicaid
OH0783261Medicare PIN
OHC03883Medicare UPIN
OH0222173Medicaid