Provider Demographics
NPI:1669478640
Name:O'KEEFE, ANDREW BENEDICT JR (DPM)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BENEDICT
Last Name:O'KEEFE
Suffix:JR
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 1:6374 N LINCOLN AVE
Mailing Address - Street 2:STE 314
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1275
Mailing Address - Country:US
Mailing Address - Phone:773-866-9800
Mailing Address - Fax:773-866-1733
Practice Address - Street 1:6374 N LINCOLN AVE
Practice Address - Street 2:STE 314
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1275
Practice Address - Country:US
Practice Address - Phone:773-866-9800
Practice Address - Fax:773-866-1733
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004954213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004954Medicaid
IL1208030001OtherDMERC
IL0001623503OtherBCBS
ILP00315818OtherRAILROAD MEDICARE
ILU76853Medicare UPIN
IL016004954Medicaid
ILP00315818OtherRAILROAD MEDICARE