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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