Provider Demographics
NPI:1861403891
Name:AGOS, ANDREW STEVE (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:STEVE
Last Name:AGOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:STEVE
Other - Last Name:AGOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2040
Mailing Address - Fax:847-733-5315
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 780
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-273-6810
Practice Address - Fax:773-273-5532
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093418208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001630046OtherBCBS OF IL GROUP NUMBER
IL036093418 1Medicaid
IL036093418 2Medicaid
IL036093418 1Medicaid
ILL84944Medicare PIN
ILG99507Medicare UPIN
IL036093418 2Medicaid