MEDICARE: GORDON CHASE WOOD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036084952	IL

General Provider Information

NPI Number	:	1225103781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON CHASE WOOD MD

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE
Second Line	:	EVANSTON HOSPITAL
City	:	EVANSTON
State	:	IL
Zip	:	60201-1718
Country	:	US
Telephone Number	:	847-570-1206
Fax Number	:	847-570-1248

Provider Business Practice Location Address
First Line	:	830 W END CT
Second Line	:	SUITE 500
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1365
Country	:	US
Telephone Number	:	847-522-8900
Fax Number	:	847-680-6177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	10/06/2020

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