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General NPI Number Information
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NPI Number | 1669789020
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Entity Type | Individual
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Provider Name | JAVIER ALFONSO GOMEZ VALENCIA MD
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Gender | Male
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 1901 W HARRISON ST
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City | CHICAGO
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State | IL
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Zip | 60612-3714
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Country | US
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Telephone | 312-864-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 W POLK ST
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City | CHICAGO
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State | IL
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Zip | 60612-3723
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Country | US
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Telephone | 312-864-6000
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036130372
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | 036-130372
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036-130372
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License Number State | IL
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