Davis, Andrew Agen

Davis, Andrew Agen is an sole proprietor health care provider with primary practice located at 8541 S State St Suite 8, Chicago IL 60619-5665. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Davis, Andrew Agen can be contacted via phone (773) 874-7711.

Contact Information

Primary practice address
8541 S State St Suite 8 Chicago IL 60619-5665
Fax: (773) 874-4721
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 036054434 Illinois

Profile Details

NPI number 1245247634
LBN Legal business name Davis, Andrew Agen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 1st, 2006
Last updated Feb 11th, 2015 - about 10 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 1245247634 NPPES
Illinois MEDICAID 036054434

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