Individual
ISSAC PEDRO DOMENECH-GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
251 E HURON ST, CHICAGO, IL 60611-2908
(502) 298-1310
Mailing address
2125 W CHICAGO AVE APT 2F, CHICAGO, IL 60622-4821
(502) 298-1310
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
125082944
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2022
Last updated
08/18/2023
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