MEDICARE: DR. JONATHAN CHARLES GAMZE 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	174400000X	Specialist		IL

General Provider Information

NPI Number	:	1154304004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN CHARLES GAMZE M.D.

Provider Business Mailing Address
First Line	:	1590 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-3906
Country	:	US
Telephone Number	:	847-342-3030
Fax Number	:	847-342-0378

Provider Business Practice Location Address
First Line	:	1590 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-3906
Country	:	US
Telephone Number	:	847-342-3030
Fax Number	:	847-342-0378

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	07/08/2007

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