Provider Demographics
NPI:1649097130
Name:KRIKELAS, ANDREW STEVEN
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:STEVEN
Last Name:KRIKELAS
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 1:5454 FARGO AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3210
Mailing Address - Country:US
Mailing Address - Phone:847-834-4923
Mailing Address - Fax:
Practice Address - Street 1:2330 S 54TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-2290
Practice Address - Country:US
Practice Address - Phone:414-615-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4778225200000X
WI2669-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant