Provider Demographics
NPI:1922745942
Name:GABISA MEDICAL CHICAGO PLLC
Entity Type:Organization
Organization Name:GABISA MEDICAL CHICAGO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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 1:7018 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2406
Mailing Address - Country:US
Mailing Address - Phone:773-961-8374
Mailing Address - Fax:888-929-2371
Practice Address - Street 1:7018 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2406
Practice Address - Country:US
Practice Address - Phone:773-961-8374
Practice Address - Fax:888-929-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care