MEDICARE: DR. CARLOS A GOMEZ 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	036086306	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	364376595	OTHER	IL	TAX ID

General Provider Information

NPI Number	:	1144327818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS A GOMEZ M.D.

Provider Business Mailing Address
First Line	:	2856 N BURLING ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5848
Country	:	US
Telephone Number	:	773-205-8200
Fax Number	:	773-205-1222

Provider Business Practice Location Address
First Line	:	4438 N MIWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-6063
Country	:	US
Telephone Number	:	773-205-8200
Fax Number	:	773-205-1222

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	02/10/2020

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