# GORMAN FAMILY MEDICAL CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699837971
- **Authorized official:** CHRISTINE GORMAN (MD)
- **Authorized official phone:** (815) 562-3784

## Contact information

- **Practice address:** 822 N 2ND ST, ROCHELLE, IL 61068-1766
- **Practice address phone:** (815) 562-3784
- **Mailing address:** PO BOX 4691, ROCKFORD, IL 61110-4691

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/14/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 07132005 | BLUE CROSS BLUE SHIELD | IL |