Healthcare Provider Details

I. General information

NPI: 1235954728
Provider Name (Legal Business Name): ANDREW MATTHEW KOWALCZYK APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 N MICHIGAN AVE STE 820
CHICAGO IL
60611-6659
US

IV. Provider business mailing address

235 W VAN BUREN ST UNIT 2607
CHICAGO IL
60607-3936
US

V. Phone/Fax

Practice location:
  • Phone: 312-202-0300
  • Fax:
Mailing address:
  • Phone: 773-814-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0414153938
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209029192
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: