Provider Demographics
NPI:1679666820
Name:GORDIN MEDICAL CENTER
Entity Type:Organization
Organization Name:GORDIN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:847-243-2110
Mailing Address - Street 1:6880 GREENWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:847-243-2110
Mailing Address - Fax:847-243-2118
Practice Address - Street 1:350 EAST DUNDEE ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3119
Practice Address - Country:US
Practice Address - Phone:847-243-2110
Practice Address - Fax:847-243-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038009488111N00000X
IL036109468207R00000X
IL042-618618261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212165Medicare PIN