Healthcare Provider Details

I. General information

NPI: 1245348291
Provider Name (Legal Business Name): ANDREW HAWRYCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 111TH AVE N SUITE 4
NAPLES FL
34108-1877
US

IV. Provider business mailing address

PO BOX 770931
NAPLES FL
34107-0931
US

V. Phone/Fax

Practice location:
  • Phone: 239-593-5000
  • Fax: 239-593-4902
Mailing address:
  • Phone: 239-593-5000
  • Fax: 239-593-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberME80588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: