Provider Demographics
NPI:1942383872
Name:REPASY, ANDREW B (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:REPASY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 118
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-503-6000
Mailing Address - Fax:311-250-3632
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 118
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-503-6000
Practice Address - Fax:311-250-3632
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL990470Medicare ID - Type Unspecified
ILD89304Medicare UPIN