Individual
JOHANA B GIMENEZRODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1276 N CLYBOURN AVE, CHICAGO, IL 60610-2003
(312) 337-1073
(312) 337-7616
Mailing address
1276 N CLYBOURN AVE, CHICAGO, IL 60610-2003
(312) 337-1073
(312) 337-7616
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036.152253
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036.152253
MD LICENSE
IL
Enumeration date
06/28/2017
Last updated
05/08/2024
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