MEDICARE: DR. RHONDA YVETTE GANS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036-085091	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11373711	OTHER	IL	CAQH

General Provider Information

NPI Number	:	1003830670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RHONDA YVETTE GANS M.D.

Provider Business Mailing Address
First Line	:	440 N MCCLURG CT APT 112
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4352
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-1600
Country	:	US
Telephone Number	:	312-646-6620
Fax Number	:	773-624-5642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/07/2023

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