Basic Information
| Provider Information | |||||||||
| NPI: | 1053303792 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PSYK | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1622 HILL SPRING DR | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815459598 | ||||||||
| FaxNumber: | 2814947399 | ||||||||
| Practice Location | |||||||||
| Address1: | 16655 SOUTHWEST FWY | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774792329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812747117 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2005 | ||||||||
| LastUpdateDate: | 09/30/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | L1171 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00128364 | 01 | TX | RAIL ROAD MEDICARE | OTHER | 8P8495 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 157354507 | 05 | TX | MEDICAID | 157354510 | 05 | TX | MEDICAID | 157354505 | 05 | TX | MEDICAID |