Healthcare Provider Details

I. General information

NPI: 1689685653
Provider Name (Legal Business Name): GWENN E GARMON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 DAMEN 11F
CHICAGO IL
60546
US

IV. Provider business mailing address

820 DAMEN 11F
CHICAGO IL
60546
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-7354
  • Fax: 312-569-7522
Mailing address:
  • Phone: 312-569-7354
  • Fax: 312-569-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: