Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Cook County

Organization Geriatric Medicine (Family Medicine) Physician · NPI 1780205708

Cook County provides Geriatric Medicine (Family Medicine) Physician services in Blue Island, Illinois. Registered with an NPI since 2020.

In the registry since
2020
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Practice location Address checks out

12757 S Western Ave
Blue Island, IL 60406
Phone: (708) 293-8400
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Geriatric Medicine (Family Medicine) Physician (primary) Taxonomy 207QG0300X

Record details

NPI number1780205708
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationCook County
Authorized official Scott Andrle — Director Of Managed Care · (312) 864-4649
Other names Cook County Health At Blue Island
NPI enumeratedApril 30, 2020
Last updated in NPPESApril 30, 2020
Certification dateApril 30, 2020
Mailing address1900 W Polk St Ste 220c, Chicago, IL 60612-3723