MEDICARE: HENRY M ANDOH M.D

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	207RI0200X	Infectious Disease Physician	36-083429	IL
2	207RI0200X	Infectious Disease Physician	01042402A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110108462	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0001606805	OTHER	IL	BLUE CROSS BLUE SHIELD
3	0004542266	OTHER	IL	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578637245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY M ANDOH M.D

Provider Business Mailing Address
First Line	:	761 45TH AVE
Second Line	:	STE. 103
City	:	MUNSTER
State	:	IN
Zip	:	46321-2893
Country	:	US
Telephone Number	:	219-922-3002
Fax Number	:	219-922-3003

Provider Business Practice Location Address
First Line	:	757 45TH AVE
Second Line	:	STE. 201
City	:	MUNSTER
State	:	IN
Zip	:	46321-2911
Country	:	US
Telephone Number	:	219-934-2461
Fax Number	:	219-934-2478

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	05/19/2021

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Directions to “ HENRY M ANDOH M.D” Practice Location

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