Healthcare Provider Details

I. General information

NPI: 1154066827
Provider Name (Legal Business Name): ALEJANDRO GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 EUCLID AVE FL 5
BERWYN IL
60402-4603
US

IV. Provider business mailing address

3231 EUCLID AVE FL 5
BERWYN IL
60402-4603
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-2000
  • Fax:
Mailing address:
  • Phone: 708-783-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.173540
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036.173540
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: