Provider Demographics
NPI:1326249285
Name:MAFLA, ANDRES FELIPE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:FELIPE
Last Name:MAFLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDRES
Other - Middle Name:FELIPE
Other - Last Name:MAFLA GRISALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:800 AUSTIN ST EAST TOWER STE 354
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-316-6600
Mailing Address - Fax:
Practice Address - Street 1:800 AUSTIN ST EAST TOWER STE 354
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-316-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
367830Medicare PIN