Provider Demographics
NPI:1467846022
Name:MALDONAD, ANDRES (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:MALDONAD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6019 S INGLESIDE AVE
Mailing Address - Street 2:APARTMENT 902
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2600
Mailing Address - Country:US
Mailing Address - Phone:412-801-2319
Mailing Address - Fax:
Practice Address - Street 1:6019 S INGLESIDE AVE
Practice Address - Street 2:APARTMENT 902
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2600
Practice Address - Country:US
Practice Address - Phone:412-801-2319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-22
Last Update Date:2015-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.064739282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital