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General NPI Number Information
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NPI Number | 1710175880
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Entity Type | Organization
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Legal Business Name | S.GUTIERREZ,III,MD SC
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Dates
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Enumeration Date | 10/14/2007
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Last Update Date | 10/25/2007
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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 | 773-862-6380
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Provider Business Mailing 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 | 773-862-6380
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SALVADOR RODOLFO GUTIERREZ III
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Credential | M.D.
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Telephone | 773-489-0133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | IL
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