MEDICARE: DR. GONZALO RODRIGUEZ-LAIZ 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	208600000X	Surgery Physician	036.172505	IL

General Provider Information

NPI Number	:	1164491338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GONZALO RODRIGUEZ-LAIZ M.D.

Provider Business Mailing Address
First Line	:	111 W WACKER DR APT 5404
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-1523
Country	:	US
Telephone Number	:	312-792-5757
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 W WACKER DR APT 5404
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-1523
Country	:	US
Telephone Number	:	312-792-5757
Fax Number	:

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	11/18/2024

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