Healthcare Provider Details

I. General information

NPI: 1245336239
Provider Name (Legal Business Name): ANDREW E KRUPITSKY DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 MAITLAND AVE SUITE 1000
ALTAMONTE SPRINGS FL
32701-4906
US

IV. Provider business mailing address

249 MAITLAND AVE SUITE 1000
ALTAMONTE SPRINGS FL
32701-4906
US

V. Phone/Fax

Practice location:
  • Phone: 407-332-6366
  • Fax: 407-830-4300
Mailing address:
  • Phone: 407-332-6366
  • Fax: 407-830-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS 5574
License Number StateFL

VIII. Authorized Official

Name: ANDREW E KRUPITSKY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 407-332-6366