Provider Demographics
NPI:1821765140
Name:GABISA MEDICAL CHICAGO PLLC
Entity Type:Organization
Organization Name:GABISA MEDICAL CHICAGO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:
Authorized Official - Last Name:VENEGAS-PIZARRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-524-1914
Mailing Address - Street 1:3436 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3322
Mailing Address - Country:US
Mailing Address - Phone:347-524-1914
Mailing Address - Fax:888-929-2371
Practice Address - Street 1:4121 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-5205
Practice Address - Country:US
Practice Address - Phone:773-697-8623
Practice Address - Fax:888-929-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health