MEDICARE: ANDREW D MCILVOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		OH

General Provider Information

NPI Number	:	1134063928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW D MCILVOY

Provider Business Mailing Address
First Line	:	20414 CREEK RIV
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2085
Country	:	US
Telephone Number	:	210-241-9634
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 CHESTER AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1666
Country	:	US
Telephone Number	:	216-368-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “ ANDREW D MCILVOY ” Practice Location

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