Healthcare Provider Details

I. General information

NPI: 1902468614
Provider Name (Legal Business Name): SAMUEL ALEXANDER LINARES GAVIDIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 W OGDEN AVE
CHICAGO IL
60612-3773
US

IV. Provider business mailing address

1969 W OGDEN AVE
CHICAGO IL
60612-3773
US

V. Phone/Fax

Practice location:
  • Phone: 312-268-6000
  • Fax:
Mailing address:
  • Phone: 312-864-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036.164584
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number036164584
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: