Individual
DR. GORDON ANDREW FUQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2131 N CLARK ST, # 9, CHICAGO, IL 60614-6188
(312) 623-8006
Mailing address
2131 N CLARK ST, # 9, CHICAGO, IL 60614-6188
(312) 623-8006
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036041997
IL
Other
Enumeration date
01/13/2012
Last updated
01/13/2012
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