MEDICARE: ANDREW KOTIS DO

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	207RI0011X	Interventional Cardiology Physician	036-086608	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982795894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW KOTIS DO

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 S MILWAUKEE AVE
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3218
Country	:	US
Telephone Number	:	847-573-2802
Fax Number	:	847-573-2837

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	10/07/2025

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