Provider Demographics
NPI:1902191539
Name:GORDON, ANDREW ALDEEN (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ALDEEN
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 1:739 S CLAREMONT AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3516
Mailing Address - Country:US
Mailing Address - Phone:646-209-3290
Mailing Address - Fax:
Practice Address - Street 1:835 S WOLCOTT AVE
Practice Address - Street 2:E-144B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3748
Practice Address - Country:US
Practice Address - Phone:312-996-7420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-11
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1321712083X0100X
FLME 1226702083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine