Individual
ANDREW NIROSHAN SELVARAJAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
635 N FAIRBANKS CT, CHICAGO, IL 60611-5435
(312) 472-3173
(312) 472-3176
Mailing address
9977 WOODS DR FL 1, SKOKIE, IL 60077-1057
(224) 364-2273
(847) 663-8290
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036147132
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0111304
—
OH
05
—
2047778
—
WA
Enumeration date
05/10/2011
Last updated
05/03/2021
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