Organization
GORMAN FAMILY MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE GORMAN (MD OWNER)
(815) 562-3784
Entity
Organization
Contact information
Practice address
822 N 2ND ST, ROCHELLE, IL 61068-1766
(815) 562-3784
Mailing address
PO BOX 4691, ROCKFORD, IL 61110-4691
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07132005
BLUE SHIELD
IL
Enumeration date
01/26/2007
Last updated
08/22/2020
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