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General NPI Number Information
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NPI Number | 1902852940
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Entity Type | Individual
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Provider Name | ANDREA IKEDA M.S., C.P., L.P.
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Gender | Female
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 815 N LARKIN AVE STE. 207
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City | JOLIET
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State | IL
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Zip | 60435-3438
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Country | US
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Telephone | 815-207-4200
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Fax | 815-207-4100
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Provider Business Mailing Address
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Address Line | 815 N LARKIN AVE STE. 207
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City | JOLIET
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State | IL
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Zip | 60435-3438
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Country | US
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Telephone | 815-207-4200
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Fax | 815-207-4100
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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 | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State | IL
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