MEDICARE: JOAQUIN B. GONZALEZ 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	207RC0000X	Cardiovascular Disease Physician	01060560A	IN
2	207RI0011X	Interventional Cardiology Physician	83659	WI
3	207RI0011X	Interventional Cardiology Physician	036-112529	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750371365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAQUIN B. GONZALEZ MD

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-9600
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3134 NORTH CLARK STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-2915
Country	:	US
Telephone Number	:	773-880-9722
Fax Number	:	312-766-4917

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	08/18/2025

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