Healthcare Provider Details

I. General information

NPI: 1225529381
Provider Name (Legal Business Name): ANDREA ELIZABETH GEDDES MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 AUSTIN ST STE 563
EVANSTON IL
60202-3456
US

IV. Provider business mailing address

800 AUSTIN ST STE 563
EVANSTON IL
60202-3456
US

V. Phone/Fax

Practice location:
  • Phone: 847-869-0522
  • Fax:
Mailing address:
  • Phone: 847-869-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036164389
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: