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General NPI Number Information
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NPI Number | 1285754879
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL MEDICAL ASSOCIATES,SC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 2551 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-2629
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Country | US
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Telephone | 773-278-7024
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Fax | 773-278-6948
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Provider Business Mailing Address
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Address Line | 2551 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60647-2629
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Country | US
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Telephone | 773-278-7024
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Fax | 773-278-6948
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GONZALO RUIZ
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Credential | M.D.
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Telephone | 773-278-7024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | IL
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