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General NPI Number Information
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NPI Number | 1164825741
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Entity Type | Individual
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Provider Name | ANDREW LIGSAY
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Gender | Male
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 676 N SAINT CLAIR ST FL 7
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City | CHICAGO
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State | IL
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Zip | 60611-2927
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Country | US
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Telephone | 916-467-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 2151 N SOUTHPORT AVE APT 2A
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City | CHICAGO
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State | IL
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Zip | 60614-4008
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Country | US
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Telephone | 916-467-6333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.165843
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License Number State | IL
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