Individual
MICHAEL GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
659 E JEFFERSON ST, FREEPORT, IL 61032-6027
(815) 229-1999
(708) 478-6387
Mailing address
659 E JEFFERSON ST, FREEPORT, IL 61032-6027
(815) 229-1999
(708) 478-6387
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
ADS1101002
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ADS1101002
ILLINOIS DEPARTENT OF AGING
IL
Enumeration date
05/24/2016
Last updated
05/24/2016
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