Organization
INFECTIOUS DISEASE SPECIALISTS OF CHICAGO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON M TRENHOLME M.D. (PRESIDENT)
(312) 942-2061
Entity
Organization
Contact information
Practice address
600 S PAULINA ST, SUITE 143, CHICAGO, IL 60612-3806
(312) 942-2061
(312) 942-2184
Mailing address
PO BOX 239D, PARK RIDGE, IL 60068-8018
(847) 732-8087
(708) 395-5223
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21623155
BLUE SHIELD GROUP #
IL
01
—
CJ6213
RR MEDICARE GROUP #
IL
Enumeration date
03/28/2006
Last updated
12/03/2007
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