MEDICARE: DR. ANDREW ALBERT INDRESANO M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	Q0940	TX

General Provider Information

NPI Number	:	1023214475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW ALBERT INDRESANO M.D

Provider Business Mailing Address
First Line	:	3160 N TARRANT PKWY STE 404
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8614
Country	:	US
Telephone Number	:	817-205-2939
Fax Number	:	817-887-3015

Provider Business Practice Location Address
First Line	:	3160 N TARRANT PKWY STE 404
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8614
Country	:	US
Telephone Number	:	817-205-2939
Fax Number	:	817-887-3015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	01/05/2022

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