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General NPI Number Information
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NPI Number | 1689802340
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Entity Type | Individual
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Provider Name | ANDREA MINA KHOSROPOUR MD
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Gender | Female
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 1541 W DEVON AVE
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City | CHICAGO
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State | IL
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Zip | 60660-1313
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Country | US
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Telephone | 773-250-5222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746715
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City | ATLANTA
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State | GA
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Zip | 30374-6715
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Country | US
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Telephone | 773-250-5222
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Fax | 773-866-8018
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.128580
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License Number State | IL
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