Healthcare Provider Details

I. General information

NPI: 1801208459
Provider Name (Legal Business Name): ANDRE L CULPEPPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LEXINGTON A CULPEPPER MD

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE STE 210
ORLAND PARK IL
60462-4686
US

IV. Provider business mailing address

912 S WOOD ST # 174N
CHICAGO IL
60612-4300
US

V. Phone/Fax

Practice location:
  • Phone: 708-226-2890
  • Fax: 708-226-2315
Mailing address:
  • Phone: 312-221-8449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101267389
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036171517
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2021-00602
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: