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General NPI Number Information
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NPI Number | 1982857512
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Entity Type | Organization
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Legal Business Name | ANDREW J. HAYDUKE, M.D. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 39000 BOB HOPE DR KIEWIT SUITE 206
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-3221
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Country | US
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Telephone | 760-341-6996
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Fax | 760-341-6776
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Provider Business Mailing Address
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Address Line | 39000 BOB HOPE DR KIEWIT SUITE 206
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-3221
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Country | US
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Telephone | 760-341-6996
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Fax | 760-341-6776
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW J HAYDUKE
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Credential | M.D.
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Telephone | 760-341-6996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A70532
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License Number State | CA
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