Provider Demographics
NPI:1275996837
Name:DE GORORDO, ALEJANDRO JAVIER
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:JAVIER
Last Name:DE GORORDO
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 1:121 S WILKE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1524
Mailing Address - Country:US
Mailing Address - Phone:847-797-4888
Mailing Address - Fax:847-739-0978
Practice Address - Street 1:121 S WILKE RD STE 110
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1524
Practice Address - Country:US
Practice Address - Phone:847-797-4888
Practice Address - Fax:847-739-0978
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036161179207LP2900X, 207LP2900X
IL390200000X
MA280286390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program