Organization
ANDREW AGEN DAVIS, MD SC
Active
Organization
ANDREW AGEN DAVIS, MD SC
Active
Other names
Andy Agen Davis, MD SC
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW AGEN DAVIS MD (PRESIDENT)
(773) 874-7711
Entity
Organization
Contact information
Practice address
8541 SO STATE STREET, SUITE 8, CHICAGO, IL 60619
(773) 874-7711
(773) 874-4721
Mailing address
8541 SOUTH STATE STREET, SUITE 8, CHICAGO, IL 60619
(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
09/12/2006
Last updated
02/06/2015
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