MEDICARE: DR. MICHAEL GOMEZ 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	208800000X	Urology Physician	036122364	IL

General Provider Information

NPI Number	:	1922277268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL GOMEZ M.D.

Provider Business Mailing Address
First Line	:	2850 S. WABASH AVE.,
Second Line	:	SUITE 106
City	:	CHICAGO
State	:	IL
Zip	:	60616-2491
Country	:	US
Telephone Number	:	312-842-4400
Fax Number	:	312-842-4595

Provider Business Practice Location Address
First Line	:	2850 S. WABASH AVE.,
Second Line	:	SUITE 106
City	:	CHICAGO
State	:	IL
Zip	:	60616-2491
Country	:	US
Telephone Number	:	312-842-4400
Fax Number	:	312-842-4595

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	07/12/2019

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Directions to “ DR. MICHAEL GOMEZ M.D.” Practice Location

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