| As Gordon Enterprise Llc | |
|
102 Center St Grayslake IL 60030-1533 | |
| (904) 477-3853 | |
| Not Available |
| Full Name | As Gordon Enterprise Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 102 Center St, Grayslake, Illinois |
| Authorized Official Name and Position | Averill Gordon (OWNER/ PRESIDENT) |
| Authorized Official Contact | 9044773853 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| As Gordon Enterprise Llc 1282 Chesterfield Ln Grayslake IL 60030-3797 Ph: (904) 477-3853 | As Gordon Enterprise Llc 102 Center St Grayslake IL 60030-1533 Ph: (904) 477-3853 |
| NPI Number | 1336884659 |
|---|---|
| Provider Enumeration Date | 05/02/2022 |
| Last Update Date | 05/02/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336884659 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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