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General NPI Number Information
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NPI Number | 1598869224
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Entity Type | Organization
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Legal Business Name | ANDREW AGEN DAVIS, MD SC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 8541 SO STATE STREET SUITE 8
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City | CHICAGO
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State | IL
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Zip | 60619
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Country | US
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Telephone | 773-874-7711
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Fax | 773-874-4721
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Provider Business Mailing Address
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Address Line | 8541 SOUTH STATE STREET SUITE 8
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City | CHICAGO
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State | IL
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Zip | 60619
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Country | US
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Telephone | 773-874-7711
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Fax | 773-874-4721
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW AGEN DAVIS
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Credential | MD
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Telephone | 773-874-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036054434
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License Number State | IL
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