Provider Demographics
NPI:1922119957
Name:GOMEZ-TORRES, AILEEN (MD)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:GOMEZ-TORRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3824
Mailing Address - Country:US
Mailing Address - Phone:773-542-5203
Mailing Address - Fax:773-542-5841
Practice Address - Street 1:3700 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3824
Practice Address - Country:US
Practice Address - Phone:773-542-5203
Practice Address - Fax:773-542-5841
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-103472208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-103472OtherSTATE LICENSE
367830Medicare PIN