Provider Demographics
NPI:1508898206
Name:GORDON, ANDREW J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:GORDON
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 1:22285 N. PEPPER ROAD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2538
Mailing Address - Country:US
Mailing Address - Phone:847-882-6604
Mailing Address - Fax:847-882-2538
Practice Address - Street 1:22285 N. PEPPER ROAD
Practice Address - Street 2:SUITE 401
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2538
Practice Address - Country:US
Practice Address - Phone:847-882-6604
Practice Address - Fax:847-882-2538
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361063432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361063431Medicaid
ILI09069Medicare UPIN
IL0361063431Medicaid