Provider Demographics
NPI:1780605717
Name:ANDRASKI, DOROTA M (MD)
Entity type:Individual
Prefix:
First Name:DOROTA
Middle Name:M
Last Name:ANDRASKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1569
Mailing Address - Country:US
Mailing Address - Phone:608-324-2000
Mailing Address - Fax:
Practice Address - Street 1:515 22ND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1569
Practice Address - Country:US
Practice Address - Phone:608-324-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-085342207R00000X
WI34904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
390808509OtherCT GENERAL
39080850909OtherUNITY
390808509OtherCIGNA
90002361OtherWEA INSURANCE
390808509OtherWPS
39080850956OtherUNITY
690004890OtherMEDICARE RAILROAD
110203056OtherMEDICARE RAILROAD
1000341OtherPHYSICIANS PLUS
31985000OtherHIRSP
WI31985000Medicaid
10849OtherDEAN HEALTH PLAN
L54540OtherMEDICARE