Individual
CLEMEN O GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1649 N PULASKI RD, CHICAGO, IL 60639-5207
(773) 278-6868
(773) 278-6922
Mailing address
1649 N PULASKI RD, CHICAGO, IL 60639-5207
(773) 278-6868
(773) 278-6922
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.152519
IL
390200000X
Student in an Organized Health Care Education/Training Program
125.070078
IL
Other
Enumeration date
05/05/2017
Last updated
04/15/2021
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