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NPI Code Detail

MEDICARE: FINEGOLD PRIMARY CARE

MEDICARE: FINEGOLD PRIMARY CARE
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
1207R00000XInternal Medicine Physician036-072555IL

General Provider Information

NPI Number : 1174644116
Entity Type Code : Organization
Provider Name (Legal Business Name) : FINEGOLD PRIMARY CARE
Provider Business Mailing Address
First Line : 5525 S PULASKI RD
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4400
Country : US
Telephone Number : 312-567-7506
Fax Number : 312-447-7484
Provider Business Practice Location Address
First Line : 5525 S PULASKI RD
Second Line :
City : CHICAGO
State : IL
Zip : 60629-4400
Country : US
Telephone Number : 312-567-7506
Fax Number : 312-447-7484
Authorized Official
Title or Position : OFFICE MANAGER
Name : SHERRY RODRIGUEZ
Credential :
Telephone Number : 708-383-5809
Provider Enumeration Date : 04/03/2007
Last Update Date : 05/02/2018

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Directions to “FINEGOLD PRIMARY CARE ” Practice Location

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