Provider Demographics
NPI:1689945792
Name:CHOUSSAL-GONZALEZ, RODOLFO (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:CHOUSSAL-GONZALEZ
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 1:2740 W FOSTER AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3532
Mailing Address - Country:US
Mailing Address - Phone:773-907-3400
Mailing Address - Fax:773-907-0341
Practice Address - Street 1:2740 W FOSTER AVE STE 410
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3532
Practice Address - Country:US
Practice Address - Phone:773-907-3400
Practice Address - Fax:773-907-0341
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT34890207R00000X, 207RI0200X, 208M00000X
IL036157658207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist