Provider Demographics
NPI:1831144476
Name:GONSCH, FLORIE A (DO)
Entity Type:Individual
Prefix:
First Name:FLORIE
Middle Name:A
Last Name:GONSCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12450 S. HARLEM AVE.
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1426
Mailing Address - Country:US
Mailing Address - Phone:708-448-1207
Mailing Address - Fax:708-229-6072
Practice Address - Street 1:12450 S. HARLEM AVE.
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1426
Practice Address - Country:US
Practice Address - Phone:708-448-1207
Practice Address - Fax:708-229-6072
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099104Medicaid
ILL72122Medicare ID - Type Unspecified
ILG99949Medicare UPIN