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NPI Code Detail

MEDICARE: R. ANDREW KOKODYNSKI

MEDICARE: R. ANDREW KOKODYNSKI
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry4764IL

General Provider Information

NPI Number : 1982751954
Entity Type Code : Individual
Provider Name (Legal Business Name) : R. ANDREW KOKODYNSKI
Provider Business Mailing Address
First Line : 851 PARK DR
Second Line : SUITE 103
City : LAKE GENEVA
State : WI
Zip : 53147-4586
Country : US
Telephone Number : 262-248-8346
Fax Number : 262-248-0130
Provider Business Practice Location Address
First Line : 851 PARK DRIVE
Second Line : SUITE 103
City : LAKE GENEVA
State : WI
Zip : 53147-4586
Country : US
Telephone Number : 262-248-8346
Fax Number : 262-248-0130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 07/08/2007

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