Healthcare Provider Details

I. General information

NPI: 1134138472
Provider Name (Legal Business Name): FRANK GONZALEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S WOOD ST M/C 808
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

820 S WOOD ST M/C 808
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7006
  • Fax:
Mailing address:
  • Phone: 317-996-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number036141912
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: