| Edwin V. Gumapas M.d. Pc | |
|
44 N Virginia St Suite 2b Crystal Lake IL 60014-4106 | |
| (815) 356-0475 | |
| (815) 356-0796 |
| Full Name | Edwin V. Gumapas M.d. Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 44 N Virginia St, Crystal Lake, Illinois |
| Authorized Official Name and Position | Dawn Thomas (OFFICE MANAGER) |
| Authorized Official Contact | 8153560475 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edwin V. Gumapas M.d. Pc 44 N Virginia St Suite 2b Crystal Lake IL 60014-4106 Ph: (815) 356-0475 | Edwin V. Gumapas M.d. Pc 44 N Virginia St Suite 2b Crystal Lake IL 60014-4106 Ph: (815) 356-0475 |
| NPI Number | 1114126000 |
|---|---|
| Provider Enumeration Date | 07/12/2007 |
| Last Update Date | 10/18/2011 |
| Medicare PECOS PAC ID | 2466357215 |
|---|---|
| Medicare Enrollment ID | O20031204000485 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114126000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 036084823 (Illinois) | Primary |
| Provider Name | Edwin V Gumapas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033101092 PECOS PAC ID: 4981509734 Enrollment ID: I20031208000368 |
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