Ikeda, Andrea

Ikeda, Andrea is an individual health care provider with primary practice located at 815 N Larkin Ave Ste. 207, Joliet IL 60435-3438. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Prosthetist, which is considered as her primary health care specialty. Ikeda, Andrea can be contacted via phone (815) 207-4200.

Contact Information

Primary practice address
815 N Larkin Ave Ste. 207 Joliet IL 60435-3438
Phone: (815) 207-4200
Fax: (815) 207-4100
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Prosthetist 224P00000X Illinois

Profile Details

NPI number 1902852940
LBN Legal business name Ikeda, Andrea
Credentials M.S., C.P., L.P.
Entity Individual
Sole proprietor 1 No
Enumeration date May 25th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902852940 NPPES
Illinois Other 09932112 BCBS
Illinois MEDICAID 113671669001 BCBS

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