Provider Demographics
NPI:1154636959
Name:ASSOCIATED FAMILY PHYSICIANS, SC
Entity Type:Organization
Organization Name:ASSOCIATED FAMILY PHYSICIANS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-392-1500
Mailing Address - Street 1:1635 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:203
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3944
Mailing Address - Country:US
Mailing Address - Phone:847-392-1500
Mailing Address - Fax:847-392-9706
Practice Address - Street 1:1635 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:203
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3944
Practice Address - Country:US
Practice Address - Phone:847-392-1500
Practice Address - Fax:847-392-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG05847Medicare UPIN