Healthcare Provider Details

I. General information

NPI: 1992807002
Provider Name (Legal Business Name): ANDREW P GEDDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 NORTH BELL SCHOOL ROAD
ROCKFORD IL
61114
US

IV. Provider business mailing address

PO BOX 78866
MILWAUKEE WI
53278-8866
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-0300
  • Fax:
Mailing address:
  • Phone: 779-696-7150
  • Fax: 779-696-7342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036093633
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: