Individual
ANDREW ROBERT GAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 COLES CENTRE DR, MATTOON, IL 61938-9314
(217) 234-5110
Mailing address
1207 NETWORK CENTRE DR, SUITE 3, EFFINGHAM, IL 62401-4632
(217) 347-2707
(217) 347-2827
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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