Provider Demographics
NPI:1104936798
Name:KRUPITSKY, ANDREW E (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:E
Last Name:KRUPITSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 MAITLAND AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4906
Mailing Address - Country:US
Mailing Address - Phone:407-332-6366
Mailing Address - Fax:407-830-4300
Practice Address - Street 1:249 MAITLAND AVE
Practice Address - Street 2:SUITE 1000
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4906
Practice Address - Country:US
Practice Address - Phone:407-332-6366
Practice Address - Fax:407-830-4300
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5574207Q00000X, 207QA0000X, 207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE66947Medicare UPIN
FL80117ZMedicare PIN