Provider Demographics
NPI:1023087715
Name:PETRYK, ANDRZEJ (MD)
Entity type:Individual
Prefix:
First Name:ANDRZEJ
Middle Name:
Last Name:PETRYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 BEAM AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1127
Mailing Address - Country:US
Mailing Address - Phone:651-779-7978
Mailing Address - Fax:651-779-7656
Practice Address - Street 1:1580 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1127
Practice Address - Country:US
Practice Address - Phone:651-779-7978
Practice Address - Fax:651-779-7656
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43012207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN275S6PEOtherBLUE CROSS BLUE SHIELD MN
MN403933500Medicaid
MN01025768OtherPREFERRED ONE
WI34051900Medicaid
MN3600229OtherMEDICA
MN1161828OtherAMERICA'S PPO
MN151274OtherUCARE MN
MNHP31687OtherHEALTHPARTNERS
WI34051900Medicaid
MN3600229OtherMEDICA
MNHP31687OtherHEALTHPARTNERS