Provider Demographics
NPI:1235257213
Name:BARTKOWSKI, ANDREW M (RPT,MSC,MBA)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:BARTKOWSKI
Suffix:
Gender:M
Credentials:RPT,MSC,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1927 SHERMAN AVE # 3
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-6100
Mailing Address - Country:US
Mailing Address - Phone:847-328-7316
Mailing Address - Fax:847-425-5155
Practice Address - Street 1:1927 SHERMAN AVE # 3
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-6100
Practice Address - Country:US
Practice Address - Phone:847-328-7316
Practice Address - Fax:847-425-5155
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070006767225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21630322Medicare UPIN