Provider Demographics
NPI:1275521320
Name:SCHUBKEGEL, ANDREW JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOSEPH
Last Name:SCHUBKEGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 EAST OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1026
Mailing Address - Country:US
Mailing Address - Phone:630-495-6000
Mailing Address - Fax:630-495-6001
Practice Address - Street 1:57 EAST OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1026
Practice Address - Country:US
Practice Address - Phone:630-495-6000
Practice Address - Fax:630-495-6001
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084344207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04 0005492OtherRAILROAD MEDICARE
IL036084344Medicaid
IL022-15697OtherBLUE CROSS AND BLUE SHIELD
ILK50422Medicare PIN