MEDICARE: ANDREA MINA KHOSROPOUR MD

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	207Q00000X	Family Medicine Physician	036.128580	IL

General Provider Information

NPI Number	:	1689802340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA MINA KHOSROPOUR MD

Provider Business Mailing Address
First Line	:	PO BOX 746715
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6715
Country	:	US
Telephone Number	:	773-250-5222
Fax Number	:	773-866-8018

Provider Business Practice Location Address
First Line	:	1541 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1313
Country	:	US
Telephone Number	:	773-250-5222
Fax Number	:

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

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	11/18/2025

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