Healthcare Provider Details

I. General information

NPI: 1679666820
Provider Name (Legal Business Name): GORDIN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 EAST DUNDEE ROAD SUITE 300
WHEELING IL
60090-3119
US

IV. Provider business mailing address

6880 GREENWOOD ROAD
NORTHBROOK IL
60062
US

V. Phone/Fax

Practice location:
  • Phone: 847-243-2110
  • Fax: 847-243-2118
Mailing address:
  • Phone: 847-243-2110
  • Fax: 847-243-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009488
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036109468
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number042-618618
License Number StateIL

VIII. Authorized Official

Name: MR. VLADIMIR GORDIN JR.
Title or Position: PRESIDENT
Credential: D.C.
Phone: 847-243-2110