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General NPI Number Information
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NPI Number | 1952824302
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Entity Type | Individual
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Provider Name | RAQUEL GONZALEZ HEREDIA MD
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Gender | Female
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 10020 DONALD S POWERS DR
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City | MUNSTER
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State | IN
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Zip | 46321-4054
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Country | US
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Telephone | 219-703-2434
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Fax | 219-703-6634
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Provider Business Mailing Address
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Address Line | 2681 N BURLING ST
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City | CHICAGO
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State | IL
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Zip | 60614-1513
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Country | US
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Telephone | 224-256-0598
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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 | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 036165199
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036165199
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 208600000X
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License Number State | IN
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