Provider Demographics
NPI:1851920276
Name:SPELIC, ANDREW JUIN (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JUIN
Last Name:SPELIC
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 1:601 E MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-7460
Mailing Address - Country:US
Mailing Address - Phone:913-359-6019
Mailing Address - Fax:913-359-5552
Practice Address - Street 1:477 COOPER RD STE 300
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8057
Practice Address - Country:US
Practice Address - Phone:380-898-8808
Practice Address - Fax:614-898-8842
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.249088390200000X
OH35145755207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program