Provider Demographics
NPI:1487006482
Name:PRELLETZ, ANDREW R (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:R
Last Name:PRELLETZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-4471
Mailing Address - Country:US
Mailing Address - Phone:847-975-2332
Mailing Address - Fax:
Practice Address - Street 1:3021 FALLING WATERS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-6745
Practice Address - Country:US
Practice Address - Phone:847-356-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL385004464363A00000X
IL085005858363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant