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General NPI Number Information
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NPI Number | 1407045289
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Entity Type | Organization
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Legal Business Name | GONZALO T FLORIDO MD SC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 714 S 10TH ST
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City | WATSEKA
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State | IL
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Zip | 60970-1827
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Country | US
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Telephone | 815-432-6744
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Fax |
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Provider Business Mailing Address
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Address Line | 714 S 10TH ST
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City | WATSEKA
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State | IL
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Zip | 60970-1827
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Country | US
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Telephone | 815-432-6744
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GONZALO T FLORIDO
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Credential | MD
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Telephone | 815-432-6744
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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 | 36-074510
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License Number State | IL
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