Provider Demographics
NPI:1346235280
Name:ANDINA, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:ANDINA
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 1:6250 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2639
Mailing Address - Country:US
Mailing Address - Phone:773-581-8400
Mailing Address - Fax:773-581-9577
Practice Address - Street 1:6250 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2639
Practice Address - Country:US
Practice Address - Phone:773-581-8400
Practice Address - Fax:773-581-9577
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059350174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059350Medicaid
IL742830Medicare ID - Type Unspecified
IL036059350Medicaid