Healthcare Provider Details

I. General information

NPI: 1811971013
Provider Name (Legal Business Name): AMERIGROUP ILLINOIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W WACKER DR SUITE 1350
CHICAGO IL
60606-1217
US

IV. Provider business mailing address

211 W WACKER DR SUITE 1350
CHICAGO IL
60606-1217
US

V. Phone/Fax

Practice location:
  • Phone: 312-214-0400
  • Fax: 312-214-0424
Mailing address:
  • Phone: 312-214-0400
  • Fax: 312-214-0424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: JARED M. ROSENTHAL
Title or Position: CEO AND PRESIDENT
Credential:
Phone: 312-214-0400