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General NPI Number Information
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NPI Number | 1174644116
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Entity Type | Organization
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Legal Business Name | FINEGOLD PRIMARY CARE
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 5525 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-4400
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Country | US
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Telephone | 312-567-7506
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Fax | 312-447-7484
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Provider Business Mailing Address
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Address Line | 5525 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-4400
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Country | US
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Telephone | 312-567-7506
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Fax | 312-447-7484
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHERRY RODRIGUEZ
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Credential |
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Telephone | 708-383-5809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-072555
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License Number State | IL
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