OrganizationActive
Cook County
NPI 1780205708 · Geriatric Medicine (Family Medicine) Physician · Blue Island, IL
Provider details
- NPI number
- 1780205708
- Entity type
- Organization
- Primary specialty
- Geriatric Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Cook County
- Authorized official
- Scott Andrle, Director of Managed Care
Mailing address
1900 W Polk St Ste 220c
Chicago, IL 60612-3723
Registry dates
- Enumerated
- 2020-04-30
- Last updated
- 2020-04-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.