Provider Demographics
NPI:1205875507
Name:ANDREWS, JERRY (DO)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 E GOLF RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4968
Mailing Address - Country:US
Mailing Address - Phone:847-378-8233
Mailing Address - Fax:
Practice Address - Street 1:657 E GOLF RD
Practice Address - Street 2:SUITE 311
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4968
Practice Address - Country:US
Practice Address - Phone:847-378-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105798Medicaid
ILH65314Medicare UPIN
IL036105798Medicaid
ILK49358Medicare PIN
ILP00478862Medicare PIN
ILL96683Medicare ID - Type UnspecifiedCOOK
ILL96684Medicare ID - Type UnspecifiedDUPAGE