Organization
ANOR MEDICAL CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ORLANDO PAULINO GONZALEZ (PRESIDENT)
(773) 637-1775
Entity
Organization
Contact information
Practice address
5241 W DIVERSEY AVE, CHICAGO, IL 60639-1501
(773) 637-1775
(773) 637-1775
Mailing address
5241 W DIVERSEY AVE, CHICAGO, IL 60639-1501
(773) 637-1775
(773) 637-1775
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
1742318
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001637066
BLUECROSS AND BLUE SHIELD
IL
Enumeration date
11/01/2007
Last updated
11/01/2007
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