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General NPI Number Information
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NPI Number | 1871750711
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Entity Type | Organization
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Legal Business Name | CARMEN GNATENCO M.D., S.C.
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 4938 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2504
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Country | US
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Telephone | 708-425-4662
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Fax | 708-452-4692
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Provider Business Mailing Address
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Address Line | 6400 W COLLEGE DR STE 600
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1900
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Country | US
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Telephone | 708-389-3224
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Fax | 708-389-3587
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JULIAN I GNATENCO
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Credential |
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Telephone | 773-742-8926
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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 |
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License Number State |
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