Provider Demographics
NPI:1598784829
Name:GOMEZ, RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:GOMEZ
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 1:410 E NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3305
Mailing Address - Country:US
Mailing Address - Phone:847-632-1680
Mailing Address - Fax:847-632-1681
Practice Address - Street 1:410 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3305
Practice Address - Country:US
Practice Address - Phone:847-632-1680
Practice Address - Fax:847-632-1681
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101711Medicaid
IL036101711Medicaid
ILK03812Medicare PIN