Provider Demographics
NPI:1194874248
Name:KRASINSKI, ANDREA ANN (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ANN
Last Name:KRASINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W 47 ST
Mailing Address - Street 2:ST 1
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:708-352-3625
Mailing Address - Fax:708-352-6304
Practice Address - Street 1:1400 W 47 ST
Practice Address - Street 2:ST 1
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-352-3625
Practice Address - Fax:708-352-6304
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063535Medicaid
741481Medicare ID - Type Unspecified
C47317Medicare UPIN