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Individual
ANDREW ROBERT GAGE
Active
Individual
ANDREW ROBERT GAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036102275
IL
208M00000X
Hospitalist Physician
036102275
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036102275
ILLINOIS PHYSICIAN LICENSE
IL
05
—
036102275
—
IL
01
—
336064010
ILLINOIS CONTROLLED SUBSTANCE LICENSE
IL
05
—
371391171003
—
IL
01
—
561920
GROUP MEDICARE
IL
01
—
561920008
MEDICARE PTAN
IL
Enumeration date
07/27/2006
Last updated
03/07/2023
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