Organization
ILLINOIS HOSPITAL MEDICINE ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK GORDON (PRESIDENT)
(865) 693-1000
Entity
Organization
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(919) 426-3140
Mailing address
5870 N HIATUS RD., STE 200, TAMARAC, FL 33321-6424
(954) 835-2848
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
Other
Enumeration date
04/01/2016
Last updated
04/01/2016
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