MEDICARE: ANDREW ROBERT GRUDZINSKI 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	208800000X	Urology Physician	21055	SC
2	208800000X	Urology Physician	20748	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00360558	OTHER	SC	RAILROAD MEDICARE
11	2280313	OTHER	NC	CIGNA MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000206911	OTHER	SC	UNISON HEALTH PLAN
2	5580793	OTHER	SC	AETNA
4	771828	OTHER	SC	WELLCARE
5	80023030	OTHER	SC	SELECT HEALTH
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	790598L	OTHER	NC	EDS
9	8522204	OTHER	SC	CIGNA
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285602151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW ROBERT GRUDZINSKI MD

Provider Business Mailing Address
First Line	:	7150 W SUNSET RD STE 201A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1981
Country	:	US
Telephone Number	:	702-902-1939
Fax Number	:	702-442-1886

Provider Business Practice Location Address
First Line	:	7500 SMOKE RANCH RD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0373
Country	:	US
Telephone Number	:	702-233-0727
Fax Number	:	702-233-4799

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	02/02/2021

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