Individual
MAYRA GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7000 CERMAK RD, BERWYN, IL 60402-2112
(708) 484-8090
Mailing address
PO BOX 746715, ATLANTA, GA 30374-6715
(708) 484-8090
(708) 445-4444
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036135401
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F400173081
MEDICARE PTAN
IL
Enumeration date
04/14/2011
Last updated
09/16/2025
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