Provider Demographics
NPI:1275528341
Name:WUNDERLICH, ANDREW WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WARREN
Last Name:WUNDERLICH
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:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-2000
Mailing Address - Fax:
Practice Address - Street 1:2000 GLENWOOD AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5676
Practice Address - Country:US
Practice Address - Phone:815-741-4445
Practice Address - Fax:815-741-3047
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106187207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106187Medicaid
H20686Medicare UPIN
IL036106187Medicaid