Provider Demographics
NPI:1235954728
Name:KOWALCZYK, ANDREW MATTHEW (APRN)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MATTHEW
Last Name:KOWALCZYK
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W VAN BUREN ST UNIT 2607
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3936
Mailing Address - Country:US
Mailing Address - Phone:773-814-0238
Mailing Address - Fax:
Practice Address - Street 1:737 N MICHIGAN AVE STE 820
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6659
Practice Address - Country:US
Practice Address - Phone:312-202-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0414153938163W00000X
IL209029192363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse