Healthcare Provider Details

I. General information

NPI: 1992732754
Provider Name (Legal Business Name): ANDREW PETER OLEKSYN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S JACKSON ST
FRANKFORT IN
46041-3313
US

IV. Provider business mailing address

111 W MAPLE ST UNIT #3406
CHICAGO IL
60610-5401
US

V. Phone/Fax

Practice location:
  • Phone: 765-656-3000
  • Fax:
Mailing address:
  • Phone: 312-787-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02002915A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: