# DR. MICHAEL GOMENDOZA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1174637110
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 036094737 | IL | — |
| 207R00000X | Internal Medicine Physician | 40250 | IA | Yes |
| 207RP1001X | Pulmonary Disease Physician | 036094737 | IL | — |

## Other

- **Enumeration date:** 08/18/2006
- **Last updated:** 12/22/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036094737 | — | IL |
| 01 | — | 110180747 | RAILROAD MEDICARE | — |