Provider Demographics
NPI:1972520542
Name:ANDINA & IRABAGON, S.C.
Entity type:Organization
Organization Name:ANDINA & IRABAGON, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-519-3132
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-0095
Mailing Address - Country:US
Mailing Address - Phone:708-218-3033
Mailing Address - Fax:773-581-9577
Practice Address - Street 1:5702 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2345
Practice Address - Country:US
Practice Address - Phone:773-581-8400
Practice Address - Fax:773-581-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty