Healthcare Provider Details

I. General information

NPI: 1417695735
Provider Name (Legal Business Name): ANDREW SAGALOV DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 1ST ST STE D434
SPRINGFIELD IL
62702-3757
US

IV. Provider business mailing address

PO BOX 19636
SPRINGFIELD IL
62794-9636
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-7063
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-7063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036173845
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: