Provider Demographics
NPI:1013931567
Name:GAGE, ANDREW ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ROBERT
Last Name:GAGE
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 1:1207 NETWORK CENTRE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4632
Mailing Address - Country:US
Mailing Address - Phone:217-347-2707
Mailing Address - Fax:217-347-2827
Practice Address - Street 1:101 COLES CENTRE DR
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9314
Practice Address - Country:US
Practice Address - Phone:217-234-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102275207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336064010OtherILLINOIS CONTROLLED SUBSTANCE LICENSE
IL561920008OtherMEDICARE PTAN
IL036102275Medicaid
IL371391171003Medicaid
IL561920OtherGROUP MEDICARE
IL036102275OtherILLINOIS PHYSICIAN LICENSE
IL036102275OtherILLINOIS PHYSICIAN LICENSE
IL148960Medicare Oscar/Certification
ILBG8563288OtherDEA