Healthcare Provider Details

I. General information

NPI: 1780650101
Provider Name (Legal Business Name): ANDREW CZESLAW ZALESKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2006
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 UPPAKRIK LN
NOKOMIS FL
34275-1755
US

IV. Provider business mailing address

2401 UPPAKRIK LANE
NOKOMIS FL
34275
US

V. Phone/Fax

Practice location:
  • Phone: 941-412-1613
  • Fax: 941-412-1613
Mailing address:
  • Phone: 941-412-1613
  • Fax: 941-412-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberME 84809
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number0101030715
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: