Organization
COLETTE B. GORDON MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TITI B THACH (BILLER)
(773) 281-7835
Entity
Organization
Contact information
Practice address
2800 N SHERIDAN RD STE 101, CHICAGO, IL 60657-6162
(773) 281-7835
(773) 281-8736
Mailing address
2800 N SHERIDAN RD STE 101, CHICAGO, IL 60657-6162
(773) 281-7835
(773) 281-8736
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036052490
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036052490
—
IL
Enumeration date
01/15/2008
Last updated
02/14/2008
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