Provider Demographics
NPI:1447247051
Name:WEST, ANDREW A (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:A
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E LYNN BLVD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1085
Mailing Address - Country:US
Mailing Address - Phone:815-626-6630
Mailing Address - Fax:815-626-6796
Practice Address - Street 1:110 E LYNN BLVD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1085
Practice Address - Country:US
Practice Address - Phone:815-626-6630
Practice Address - Fax:815-626-6796
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068312173000000X
IL036038312207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205023Medicare ID - Type Unspecified
ILG12707Medicare UPIN