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General NPI Number Information
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NPI Number | 1164522769
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Entity Type | Individual
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Provider Name | SALVADOR RODOLFO GUTIERREZ III M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 07/12/2019
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Provider Practice Location Address
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Address Line | 2655 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-1643
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Country | US
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Telephone | 773-489-0133
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Fax |
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Provider Business Mailing Address
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Address Line | 109 POPLAR CT
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City | NORTHBROOK
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State | IL
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Zip | 60062-1035
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Country | US
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Telephone | 847-564-4836
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036087656
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License Number State | IL
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