Healthcare Provider Details

I. General information

NPI: 1780547307
Provider Name (Legal Business Name): ANDREW ELDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 N MAIN ST STE 200
SANDWICH IL
60548-1397
US

IV. Provider business mailing address

836 SHAGBARK LN APT 301
NORTH AURORA IL
60542-1434
US

V. Phone/Fax

Practice location:
  • Phone: 630-687-5981
  • Fax: 815-981-7530
Mailing address:
  • Phone: 630-687-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: