Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036.147862 | IL |
Y | 208000000X | Pediatrician | 46329 | MN |
NPI | 1003808114 |
---|---|
Provider Name | John S Andrews |
First Address | Chicago, IL 60611-5885 |
Second Address | Chicago, IL 60614-1881 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 19/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
612307400 | (05) | MN |
E69305 | (02) |