Organization
PRUDENCE L. GOURGUECHON, M.D. S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRUDENCE L GOURGUECHON MD (PRESIDENT)
(773) 878-8082
Entity
Organization
Contact information
Practice address
1454 W FARRAGUT AVE, CHICAGO, IL 60640-2104
(773) 878-8082
Mailing address
1454 W FARRAGUT AVE, CHICAGO, IL 60640-2104
(773) 878-8082
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
Primary
036062459
IL
Other
Enumeration date
12/06/2009
Last updated
12/06/2009
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