Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS5574 | FL |
N | 207QA0505X | Family Doctor - Adult Medicine | OS5574 | FL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | OS5574 | FL |
NPI | 1104936798 |
---|---|
Provider Name | Andrew E Krupitsky |
First Address | Altamonte Springs, FL 32701-4906 |
Second Address | Altamonte Springs, FL 32701-4906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 23/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E66947 | (02) | FL |