Individual
ANDREW AGEN DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8541 S STATE ST, SUITE 8, CHICAGO, IL 60619-5665
(773) 874-7711
(773) 874-4721
Mailing address
8541 S STATE ST, SUITE 8, CHICAGO, IL 60619-5665
(773) 874-7711
(773) 874-4721
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036054434
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036054434
—
IL
Enumeration date
08/01/2006
Last updated
02/11/2015
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