Healthcare Provider Details

I. General information

NPI: 1164825741
Provider Name (Legal Business Name): ANDREW LIGSAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST FL 7
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

2151 N SOUTHPORT AVE APT 2A
CHICAGO IL
60614-4008
US

V. Phone/Fax

Practice location:
  • Phone: 916-467-6333
  • Fax:
Mailing address:
  • Phone: 916-467-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.165843
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: