Individual
GARY RAY FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4025 N SHERIDAN RD, CHICAGO, IL 60613-2010
(773) 388-1600
Mailing address
4025 N SHERIDAN RD, CHICAGO, IL 60613-2010
(773) 388-1600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.138490
IL
207Q00000X
Family Medicine Physician
125-062008
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036.138490
—
IL
Enumeration date
07/09/2012
Last updated
08/03/2023
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