MEDICARE: MILOSLAVA ANDRST MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	140389	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174678825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILOSLAVA ANDRST MD

Provider Business Mailing Address
First Line	:	82 MIDDLE COUNTRY RD
Second Line	:	ELSIE OWENS NORTH BROOKHAVEN HEALTH CENTER
City	:	CORAM
State	:	NY
Zip	:	11727-4411
Country	:	US
Telephone Number	:	631-854-2301
Fax Number	:	631-854-2298

Provider Business Practice Location Address
First Line	:	82 MIDDLE COUNTRY RD
Second Line	:	ELSIE OWENS NORTH BROOKHAVEN HEALTH CENTER
City	:	CORAM
State	:	NY
Zip	:	11727-4411
Country	:	US
Telephone Number	:	631-854-2301
Fax Number	:	631-854-2298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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