Healthcare Provider Details

I. General information

NPI: 1982795894
Provider Name (Legal Business Name): ANDREW KOTIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3218
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-573-2802
  • Fax: 847-573-2837
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036-086608
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: