Provider Demographics
NPI:1366460933
Name:GIRALDO, ANDRES ALBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:ALBERTO
Last Name:GIRALDO
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 1:6540 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3927
Mailing Address - Country:US
Mailing Address - Phone:847-779-7700
Mailing Address - Fax:847-779-7701
Practice Address - Street 1:6540 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3927
Practice Address - Country:US
Practice Address - Phone:847-779-7700
Practice Address - Fax:847-779-7701
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104998Medicaid
IL110245995OtherMEDICARE RAILROAD
ILCC0436OtherMEDICARE RAILROAD
ILCC0436OtherMEDICARE RAILROAD
IL110245995OtherMEDICARE RAILROAD