Healthcare Provider Details

I. General information

NPI: 1912155888
Provider Name (Legal Business Name): KELLY MARIE GORZ D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

666 DUNDEE RD STE 307
NORTHBROOK IL
60062-2726
US

IV. Provider business mailing address

666 DUNDEE RD STE 307
NORTHBROOK IL
60062-2726
US

V. Phone/Fax

Practice location:
  • Phone: 312-339-7698
  • Fax:
Mailing address:
  • Phone: 312-339-7698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181000345
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: