Individual
MICHAEL GORDON
Active
Individual
MICHAEL GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
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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