Provider Demographics
NPI:1801208459
Name:CULPEPPER, ANDRE L (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:L
Last Name:CULPEPPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LEXINGTON
Other - Middle Name:A
Other - Last Name:CULPEPPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:912 S WOOD ST # 174N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4300
Mailing Address - Country:US
Mailing Address - Phone:312-221-8449
Mailing Address - Fax:
Practice Address - Street 1:15300 WEST AVE STE 210
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4686
Practice Address - Country:US
Practice Address - Phone:708-226-2890
Practice Address - Fax:708-226-2315
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012673892084N0400X
390200000X
IL0361715172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program