# DR. ANDRES FAJARDO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1447417829
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 01065981A | IN | Yes |

## Other

- **Enumeration date:** 05/22/2008
- **Last updated:** 08/09/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200980740 | — | IN |
| 01 | — | 815500263 | MEDICARE PTAN | IN |
| 01 | — | M400018709 | MEDICARE PTAN | IN |
| 01 | — | P00911441 | RAILROAD PTAN | IN |