Provider Demographics
NPI:1104823228
Name:GONZALZLES, ARMAND A (MD)
Entity Type:Individual
Prefix:DR
First Name:ARMAND
Middle Name:A
Last Name:GONZALZLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 W. WASHINGTON BLVD
Mailing Address - Street 2:M/C 698
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2428
Mailing Address - Country:US
Mailing Address - Phone:312-996-2000
Mailing Address - Fax:312-413-7812
Practice Address - Street 1:2045 W. WASHINGTON BLVD
Practice Address - Street 2:M/C 698
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2428
Practice Address - Country:US
Practice Address - Phone:312-996-2000
Practice Address - Fax:312-413-7812
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-04-28
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
IL036052969208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052969Medicaid
ILE84418Medicare UPIN
IL947320Medicare ID - Type Unspecified