MEDICARE: AMERIGROUP ILLINOIS, INC.

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1811971013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERIGROUP ILLINOIS, INC.

Provider Business Mailing Address
First Line	:	211 W WACKER DR
Second Line	:	SUITE 1350
City	:	CHICAGO
State	:	IL
Zip	:	60606-1217
Country	:	US
Telephone Number	:	312-214-0400
Fax Number	:	312-214-0424

Provider Business Practice Location Address
First Line	:	211 W WACKER DR
Second Line	:	SUITE 1350
City	:	CHICAGO
State	:	IL
Zip	:	60606-1217
Country	:	US
Telephone Number	:	312-214-0400
Fax Number	:	312-214-0424

Authorized Official
Title or Position	:	CEO AND PRESIDENT
Name	:	JARED M. ROSENTHAL
Credential	:
Telephone Number	:	312-214-0400

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	08/22/2020

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