Provider Demographics
NPI:1770662637
Name:GONZALEZ-OROZCO, LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:GONZALEZ-OROZCO
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 1:1460 WEDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1316
Mailing Address - Country:US
Mailing Address - Phone:847-759-0427
Mailing Address - Fax:
Practice Address - Street 1:494 LEE ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4607
Practice Address - Country:US
Practice Address - Phone:847-297-1515
Practice Address - Fax:847-297-3390
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03605590702Medicaid
IL03605590702Medicaid
IL206926Medicare ID - Type Unspecified