Provider Demographics
NPI:1639395304
Name:GONZALEZ, LENORE EVANS (MD)
Entity Type:Individual
Prefix:DR
First Name:LENORE
Middle Name:EVANS
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LENORE
Other - Middle Name:INA
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:236 S 5TH ST
Mailing Address - Street 2:APT C
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701-1431
Mailing Address - Country:US
Mailing Address - Phone:312-259-7986
Mailing Address - Fax:
Practice Address - Street 1:236 S 5TH ST
Practice Address - Street 2:APT C
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1431
Practice Address - Country:US
Practice Address - Phone:312-259-7986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBG7726788OtherDEA CONTROLLED SUBSTANCES