Provider Demographics
NPI:1225103781
Name:WOOD, GORDON CHASE (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:CHASE
Last Name:WOOD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:830 W END CT
Practice Address - Street 2:SUITE 500
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1365
Practice Address - Country:US
Practice Address - Phone:847-522-8900
Practice Address - Fax:847-680-6177
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2020-10-06
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Provider Licenses
StateLicense IDTaxonomies
IL036084952208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F37515Medicare UPIN