Healthcare Provider Details

I. General information

NPI: 1013931567
Provider Name (Legal Business Name): ANDREW ROBERT GAGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/07/2023
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COLES CENTRE DR
MATTOON IL
61938-9314
US

IV. Provider business mailing address

1207 NETWORK CENTRE DR SUITE 3
EFFINGHAM IL
62401-4632
US

V. Phone/Fax

Practice location:
  • Phone: 217-234-5110
  • Fax:
Mailing address:
  • Phone: 217-347-2707
  • Fax: 217-347-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036102275
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036102275
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: