Provider Demographics
NPI:1033270046
Name:GORDEUK, VICTOR R (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:R
Last Name:GORDEUK
Suffix:
Gender:M
Credentials:MD
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Other - Last Name Type:
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Mailing Address - Street 1:820 S WOOD ST
Mailing Address - Street 2:SICKLE CELL CTR. SUITE 172, CLINICAL SCIENCES BUILDING
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-5680
Mailing Address - Fax:312-996-5984
Practice Address - Street 1:820 S WOOD ST
Practice Address - Street 2:SICKLE CELL CTR. SUITE 172, CLINICAL SCIENCES BUILDING
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-996-5680
Practice Address - Fax:312-996-5984
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2012-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DCMD20534207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD136321200Medicaid
DC028681600Medicaid
VA5881943Medicaid
00B584H13Medicare PIN
MD136321200Medicaid