Provider Demographics
NPI:1578911061
Name:GORDON, ANDREW C (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:240 E HURON ST STE 1-200
Mailing Address - Street 2:NORTHWESTERN MEDICINE MCGAW MEDICAL CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2909
Mailing Address - Country:US
Mailing Address - Phone:312-503-7975
Mailing Address - Fax:
Practice Address - Street 1:251 E HURON ST STE 4-710
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-695-1791
Practice Address - Fax:312-695-5645
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.072323208600000X
IL036.1706252085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery