Provider Demographics
NPI:1407968571
Name:OSTAPCHUK, ANDREW PETER (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PETER
Last Name:OSTAPCHUK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 JUPITER LAKES BLVD
Mailing Address - Street 2:BLDG 3000 STE 101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7191
Mailing Address - Country:US
Mailing Address - Phone:561-743-0410
Mailing Address - Fax:561-745-3008
Practice Address - Street 1:210 JUPITER LAKES BLVD
Practice Address - Street 2:BLDG 3000 STE 101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7191
Practice Address - Country:US
Practice Address - Phone:561-743-0410
Practice Address - Fax:561-745-3008
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2057213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052053500Medicaid
FL052053500Medicaid
FL65121Medicare ID - Type Unspecified