Provider Demographics
NPI:1912988783
Name:GONZALEZ, MARIA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:E
Last Name:GONZALEZ
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 1:794 W DUNDEE RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2652
Mailing Address - Country:US
Mailing Address - Phone:847-229-0505
Mailing Address - Fax:847-229-9405
Practice Address - Street 1:794 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2652
Practice Address - Country:US
Practice Address - Phone:847-229-0505
Practice Address - Fax:847-229-9405
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090259Medicaid
ILG07552Medicare UPIN
IL207572Medicare ID - Type Unspecified