Provider Demographics
NPI:1558484121
Name:MAKELA, ANDREW
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:MAKELA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 JASMINE CIR
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-4946
Mailing Address - Country:US
Mailing Address - Phone:847-265-1507
Mailing Address - Fax:262-796-3930
Practice Address - Street 1:15455 W BLUEMOUND RD
Practice Address - Street 2:SUITE 240
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4007
Practice Address - Country:US
Practice Address - Phone:262-796-3937
Practice Address - Fax:262-796-3930
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3000-035152W00000X
IL046.009718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist