Healthcare Provider Details

I. General information

NPI: 1588026538
Provider Name (Legal Business Name): ANDREY PRILUTSKIY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-2646
US

IV. Provider business mailing address

5409 S RIDGE WAY
MIDDLETON WI
53562-1204
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-8443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number281760
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number75423-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: