Provider Demographics
NPI:1962481143
Name:ANDROS, GREGORY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:ANDROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1541 RIVERBOAT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-9341
Mailing Address - Country:US
Mailing Address - Phone:815-409-4930
Mailing Address - Fax:815-741-3825
Practice Address - Street 1:1541 RIVERBOAT CENTER DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-9341
Practice Address - Country:US
Practice Address - Phone:815-741-3825
Practice Address - Fax:815-741-3263
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036089141208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03689141Medicaid
ILG41660Medicare UPIN
IL03689141Medicaid