Provider Demographics
NPI:1750498168
Name:HONIGSBLUM, ANDREA CAMILLE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CAMILLE
Last Name:HONIGSBLUM
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:9650 GROSS POINT RD STE 1900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-5006
Mailing Address - Country:US
Mailing Address - Phone:224-251-2020
Mailing Address - Fax:224-251-2010
Practice Address - Street 1:9650 GROSS POINT RD STE 1900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-5006
Practice Address - Country:US
Practice Address - Phone:224-251-2020
Practice Address - Fax:224-251-2010
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036106521207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106521OtherIL STATE MEDIAL LICENSE
IL202101Medicare ID - Type Unspecified