Provider Demographics
NPI:1063640134
Name:HAJDUK, ANDREW JAMES (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:HAJDUK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:5502 WASHINGTON AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4093
Practice Address - Country:US
Practice Address - Phone:262-637-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-017222225100000X
WI11862-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00750703OtherMEDICARE RAILROAD
IL216859022Medicare PIN
ILP00750703OtherMEDICARE RAILROAD
WIK400153182Medicare PIN
WI832070044Medicare PIN