| Doctor Name: | ANDRES MARTIN ACOSTA |
| NPI Number: | 1275948127 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 33128-1 |
| Business Practice Address: | 820 S Wood St Chicago, IL - 606124325 |
| Business Phone Number: | 3128356957 |
| Business Fax Number: | |
| Mailing Address: | 6446 N Seeley Ave Apt 2, CHICAGO |
| State: | IL |
| Postal Code: | 606455604 |
| Phone Number: | 3128356957 |
| Fax Number: | |
| NPI Enumeration Date: | 06/29/2014 |
| NPI Last Update Date: | 06/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 33128-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ZZ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |