Organization
S.GUTIERREZ,III,MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SALVADOR RODOLFO GUTIERREZ III M.D. (PRESIDENT)
(773) 489-0133
Entity
Organization
Contact information
Practice address
2655 N MILWAUKEE AVE, CHICAGO, IL 60647-1643
(773) 489-0133
(773) 862-6380
Mailing address
2655 N MILWAUKEE AVE, CHICAGO, IL 60647-1643
(773) 489-0133
(773) 862-6380
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01634265
BCBS
IL
01
—
1164522769
NPI
IL
01
—
209035
MEDICARE GRP. ID
IL
Enumeration date
10/14/2007
Last updated
10/25/2007
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