Provider Demographics
NPI:1134195134
Name:KREEK, ANDREW E JR (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:E
Last Name:KREEK
Suffix:JR
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 1:1604 GUNBARREL RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3125
Mailing Address - Country:US
Mailing Address - Phone:423-648-2395
Mailing Address - Fax:423-648-7542
Practice Address - Street 1:1604 GUNBARREL RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3125
Practice Address - Country:US
Practice Address - Phone:423-893-7226
Practice Address - Fax:423-893-7398
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0512442085R0202X
TN362242085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA085850904Medicaid
GA792236OtherBCBS
GA632297OtherBCBS OF GA
TN3878141Medicaid
TN4073008OtherBCBS OF TN
TN4042935OtherBCBS
GA632297OtherBCBS OF GA
GA085850904Medicaid
TNP00048434Medicare PIN
TN3878141Medicare PIN
TN3878142Medicare PIN
GAP00045957Medicare PIN
H33625Medicare UPIN
GAP00103249Medicare PIN