Healthcare Provider Details

I. General information

NPI: 1154345635
Provider Name (Legal Business Name): ABINA GONCALVES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 S MICHIGAN AVE
CHICAGO IL
60653-1019
US

IV. Provider business mailing address

500 E 51ST ST DEPARTMENT OF FAMILY MEDICINE
CHICAGO IL
60615-2400
US

V. Phone/Fax

Practice location:
  • Phone: 312-945-4010
  • Fax: 312-945-4088
Mailing address:
  • Phone: 312-572-2675
  • Fax: 312-572-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: