Provider Demographics
NPI:1235589730
Name:CLAUDIO-GONZALEZ, IVAN
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:CLAUDIO-GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3877
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60434-3877
Mailing Address - Country:US
Mailing Address - Phone:815-714-7171
Mailing Address - Fax:
Practice Address - Street 1:601A PROFESSIONAL DR
Practice Address - Street 2:SUITE 235
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7697
Practice Address - Country:US
Practice Address - Phone:470-292-3957
Practice Address - Fax:470-292-3683
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88721207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology