Provider Demographics
NPI:1619350410
Name:ANEZ DE GOMEZ, CRISTINA ISABEL (MD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:ISABEL
Last Name:ANEZ DE GOMEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 GREEN BAY ROAD 1083 RWCLC
Mailing Address - Street 2:
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3037
Mailing Address - Country:US
Mailing Address - Phone:618-722-6221
Mailing Address - Fax:
Practice Address - Street 1:800 N WESTMORELAND RD STE 201
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1687
Practice Address - Country:US
Practice Address - Phone:847-535-7157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125067298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine