MEDICARE: ANDREW JOHN HOSSLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	036143712	IL
2	207Q00000X	Family Medicine Physician	036-143712	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	214881	OTHER	IL	MULTISPECIALTY GROUP PTAN

General Provider Information

NPI Number	:	1710392428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW JOHN HOSSLER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3988
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62902-3988
Country	:	US
Telephone Number	:	618-457-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 W JACKSON ST STE 101
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-1408
Country	:	US
Telephone Number	:	618-457-6787
Fax Number	:	618-351-4804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	03/05/2021

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