Healthcare Provider Details

I. General information

NPI: 1487186714
Provider Name (Legal Business Name): WESTON GARRETT ANDREWS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 05/21/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19475 W NORTH AVE
BROOKFIELD WI
53045-4199
US

IV. Provider business mailing address

401 E INDUSTRIAL DR UNIT 627
HARTLAND WI
53029-0820
US

V. Phone/Fax

Practice location:
  • Phone: 414-850-7586
  • Fax:
Mailing address:
  • Phone: 414-850-7586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number82014-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number82014-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number82014-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: