MEDICARE: ANDREW P SZPUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2021524	OTHER	IL	ISBE

General Provider Information

NPI Number	:	1811401433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW P SZPUR

Provider Business Mailing Address
First Line	:	11242 S LONGWOOD DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4126
Country	:	US
Telephone Number	:	773-708-7440
Fax Number	:

Provider Business Practice Location Address
First Line	:	11242 S LONGWOOD DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4126
Country	:	US
Telephone Number	:	773-708-7440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2017
Last Update Date	:	11/17/2017

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