Provider Demographics
NPI:1689802340
Name:KHOSROPOUR, ANDREA MINA (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MINA
Last Name:KHOSROPOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4848 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2718
Mailing Address - Country:US
Mailing Address - Phone:773-724-6200
Mailing Address - Fax:773-564-3510
Practice Address - Street 1:213 N RACINE AVE
Practice Address - Street 2:100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1644
Practice Address - Country:US
Practice Address - Phone:312-773-9730
Practice Address - Fax:773-866-8014
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2015-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL125057197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine