Provider Demographics
NPI:1316345077
Name:KRIVOSHIK, ANDREW PETER (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PETER
Last Name:KRIVOSHIK
Suffix:
Gender:
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2507
Mailing Address - Country:US
Mailing Address - Phone:847-735-9737
Mailing Address - Fax:
Practice Address - Street 1:421 E CENTER AVE
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2507
Practice Address - Country:US
Practice Address - Phone:847-735-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015840208000000X, 208U00000X
NC200200389208000000X, 2080P0207X
MN42674208000000X
IL036111634208000000X, 208U00000X
MI4301113666208000000X
WI69592-20208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology