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NPI Code Detail

MEDICARE: DR. MIGUEL ANGEL GONZALEZ O.D.

MEDICARE: DR. MIGUEL ANGEL GONZALEZ O.D.
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
1152W00000XOptometristIL

General Provider Information

NPI Number : 1235253550
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MIGUEL ANGEL GONZALEZ O.D.
Provider Business Mailing Address
First Line : 1212 N LA SALLE DR
Second Line : #2303
City : CHICAGO
State : IL
Zip : 60610-8027
Country : US
Telephone Number : 312-209-1043
Fax Number : 312-226-0838
Provider Business Practice Location Address
First Line : 1254 S CANAL ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-5213
Country : US
Telephone Number : 312-226-0653
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 07/08/2007

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