Andrzej Petryk, M.D.

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

43012 Issued in MN

Practice address

1580 Beam Ave
Maplewood, MN 55109-1127

Phone

(651) 779-7978

Fax

(651) 779-7656

NPI assigned

Mar 15, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Minnesota Oncology Hematology, PA

  • Hematology & Oncology Physician
  • Saint Paul, MN
  • NPI 1528035995
  NPD (past)
• Minnesota Oncology Hematology, PA

  • Radiation Oncology Physician
  • Saint Paul, MN
  • NPI 1598305427
  NPD (past)
• Minnesota Oncology Hematology, PA

  • Hematology & Oncology Physician
  • Saint Paul, MN
  • NPI 1609911205
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318464000000",
    "number": "1023087715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1580 BEAM AVE",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091127",
            "telephone_number": "651-779-7978",
            "fax_number": "651-779-7656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 BEAM AVE",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091127",
            "telephone_number": "651-779-7978",
            "fax_number": "651-779-7656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRYK",
        "first_name": "ANDRZEJ",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2011-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MN",
            "license": "43012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MN",
            "identifier": "275S6PE",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403933500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "01025768",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34051900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "3600229",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICA'S PPO",
            "identifier": "1161828",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MN",
            "identifier": "151274",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP31687",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Duc The Pham, PHARMD, RPH
• Krista Marie Phelps, OTR
• Donald Phillips
• Heather Phillips, M.D.
• Phoenix Adolescent Outpatient Treatment

• Hematology & Oncology Physician in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Hematology & Oncology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.