Dr Henry Gonzales, DPM | |
2008 N Pulaski Rd, Chicago, IL 60639-3767 | |
(773) 968-6942 | |
Not Available |
Full Name | Dr Henry Gonzales |
---|---|
Gender | Male |
Speciality | Podiatrist |
Location | 2008 N Pulaski Rd, Chicago, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1053466797 | NPI | - | NPPES |
016-005275 | Other | IL | LIC POD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | 016-005275 (Illinois) | Primary |
Provider Name | Podiatry Homecare Sc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1598184863 PECOS PAC ID: 5799918157 Enrollment ID: O20140509000775 |
Mailing Address | Practice Location Address |
---|---|
Dr Henry Gonzales, DPM 10225a Camden Ln, Bridgeview, IL 60455-5500 Ph: (708) 790-1303 | Dr Henry Gonzales, DPM 2008 N Pulaski Rd, Chicago, IL 60639-3767 Ph: (773) 968-6942 |
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