Healthcare Provider Details

I. General information

NPI: 1982975678
Provider Name (Legal Business Name): ANDREW J BIEBER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5949 W RAYMOND ST
INDIANAPOLIS IN
46241-4348
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 317-247-1579
  • Fax: 630-296-2223
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-3251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36001483A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: