Provider Demographics
NPI:1588736474
Name:HANZLIK, ANDREW J (MD PA)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:HANZLIK
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 470788
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-0788
Mailing Address - Country:US
Mailing Address - Phone:863-421-9898
Mailing Address - Fax:863-421-8979
Practice Address - Street 1:2215 NORTH BLVD WEST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837
Practice Address - Country:US
Practice Address - Phone:863-421-9898
Practice Address - Fax:863-421-8979
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73735207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42339BMedicare ID - Type Unspecified
G63195Medicare UPIN