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1356837868

NPI Code Detail

MEDICARE: DR. RAYMOND GONZALES MD

MEDICARE: DR. RAYMOND GONZALES MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	036.160761	IL
2	2084P0800X	Psychiatry Physician	036.160761	IL
3	2084P0800X	Psychiatry Physician	14214	WI
4	2084P0800X	Psychiatry Physician	ME147598	FL

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

General Provider Information

NPI Number	:	1356837868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND GONZALES MD

Provider Business Mailing Address
First Line	:	203 N LASALLE ST
Second Line	:	STE 2100
City	:	CHICAGO
State	:	IL
Zip	:	60611-4566
Country	:	US
Telephone Number	:	312-600-8680
Fax Number	:	330-828-7637

Provider Business Practice Location Address
First Line	:	2948 ARTESIAN RD STE 112
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8559
Country	:	US
Telephone Number	:	630-428-7890
Fax Number	:	630-428-7891

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	06/03/2026

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Directions to “ DR. RAYMOND GONZALES MD” Practice Location

Language	Start Address	Practice Location

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