MEDICARE: FLORIE A GONSCH D.O.

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	207R00000X	Internal Medicine Physician	036099104	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

General Provider Information

NPI Number	:	1831144476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLORIE A GONSCH D.O.

Provider Business Mailing Address
First Line	:	12450 S. HARLEM AVE.
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1426
Country	:	US
Telephone Number	:	708-448-1207
Fax Number	:	708-229-6072

Provider Business Practice Location Address
First Line	:	12450 S. HARLEM AVE.
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1426
Country	:	US
Telephone Number	:	708-448-1207
Fax Number	:	708-229-6072

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	06/18/2014

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