Basic Information
| Provider Information | |||||||||
| NPI: | 1255771358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | GREGORY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2740 W FOSTER AVENUE | ||||||||
| Address2: | SWEDISH COVENANT MEDICAL GROUP | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738788200 | ||||||||
| FaxNumber: | 7732938804 | ||||||||
| Practice Location | |||||||||
| Address1: | 5145 N CALIFORNIA AVE STE M276 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606253661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738788200 | ||||||||
| FaxNumber: | 7739891734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2013 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036.143664 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 036.143664 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.