Organization
PEDIATRIC MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GISELA GONZALEZ M.D. (PRESIDENT)
(224) 616-9749
Entity
Organization
Contact information
Practice address
601 W CENTRAL RD, SUITE 1, MT PROSPECT, IL 60056-2379
(847) 222-0999
(847) 203-0203
Mailing address
902 FLORENCE DR, PARK RIDGE, IL 60068-2108
(224) 616-9749
(630) 894-3280
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036083477
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036083477
—
IL
Enumeration date
03/22/2011
Last updated
03/22/2011
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