MEDICARE: DR. ANDRES MALDONAD M.D., PHD

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	282N00000X	General Acute Care Hospital	125.064739	IL

General Provider Information

NPI Number	:	1467846022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRES MALDONAD M.D., PHD

Provider Business Mailing Address
First Line	:	6019 S INGLESIDE AVE
Second Line	:	APARTMENT 902
City	:	CHICAGO
State	:	IL
Zip	:	60637-2600
Country	:	US
Telephone Number	:	412-801-2319
Fax Number	:

Provider Business Practice Location Address
First Line	:	6019 S INGLESIDE AVE
Second Line	:	APARTMENT 902
City	:	CHICAGO
State	:	IL
Zip	:	60637-2600
Country	:	US
Telephone Number	:	412-801-2319
Fax Number	:

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

Provider Enumeration Date	:	03/22/2015
Last Update Date	:	03/22/2015

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