Individual
MARTIN J GONZALEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
2525 S MICHIGAN AVE, B-522, CHICAGO, IL 60616-2333
(312) 567-5550
(312) 567-2079
Mailing address
2525 S MICHIGAN AVE, B-522, CHICAGO, IL 60616-2333
(312) 567-5550
(312) 567-2079
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
056002902
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621679
BCBS
IL
Enumeration date
05/27/2010
Last updated
05/27/2010
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