Healthcare Provider Details

I. General information

NPI: 1871278655
Provider Name (Legal Business Name): ANDREW MARQUES VIERRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDREW MARQUES SIMON-VIERRA MD

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S LIMESTONE
LEXINGTON KY
40506-0007
US

IV. Provider business mailing address

104 HAWKS BILL CT
NICHOLASVILLE KY
40356-7036
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-1000
  • Fax:
Mailing address:
  • Phone: 360-689-5183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number61908
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4351050966
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01100095A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: