Healthcare Provider Details

I. General information

NPI: 1851580054
Provider Name (Legal Business Name): ANDREW YICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR BRANDON REGIONAL HOSPITAL EMERGENCY DEPARTMENT
BRANDON FL
33511-5779
US

IV. Provider business mailing address

1802 ABBEY TRACE DR
DOVER FL
33527-6002
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-5551
  • Fax:
Mailing address:
  • Phone: 813-416-6744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number57013277
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberME 109669
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: