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General NPI Number Information
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NPI Number | 1972520542
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Entity Type | Organization
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Legal Business Name | ANDINA & IRABAGON, S.C.
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 5702 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2345
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Country | US
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Telephone | 773-581-8400
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Fax | 773-581-9577
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Provider Business Mailing Address
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Address Line | PO BOX 95
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City | ORLAND PARK
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State | IL
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Zip | 60462-0095
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Country | US
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Telephone | 708-218-3033
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Fax | 773-581-9577
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT J ANDINA
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Credential | MD
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Telephone | 773-519-3132
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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 |
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License Number State |
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