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General NPI Number Information
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NPI Number | 1538939863
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Entity Type | Individual
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Provider Name | GEORGE NICHOLAS ANDRETICH
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Gender | Male
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 666 DUNDEE RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-2727
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Country | US
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Telephone | 847-714-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 16044 W PENNYROYAL LN
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City | LOCKPORT
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State | IL
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Zip | 60441
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Country | US
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Telephone | 708-846-2405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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