Healthcare Provider Details

I. General information

NPI: 1356341994
Provider Name (Legal Business Name): PAUL JAMES GORDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10604 SOUTHWEST HWY STE 101
CHICAGO RIDGE IL
60415
US

IV. Provider business mailing address

10604 SOUTHWEST HWY STE 101
CHICAGO RIDGE IL
60415-2704
US

V. Phone/Fax

Practice location:
  • Phone: 708-346-4065
  • Fax: 708-423-5799
Mailing address:
  • Phone: 708-346-4065
  • Fax: 708-423-5799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number01046920A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036095321
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: