| Gustavo A . Pedraza M.d., Ltd | |
|
23952 S Northern Illinois Dr Channahon IL 60410-5184 | |
| (815) 467-4114 | |
| (815) 467-1774 |
| Full Name | Gustavo A . Pedraza M.d., Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 23952 S Northern Illinois Dr, Channahon, Illinois |
| Authorized Official Name and Position | Gustavo A Pedraza (PRESIDENT) |
| Authorized Official Contact | 8154674114 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gustavo A . Pedraza M.d., Ltd 23952 S Northern Illinois Dr P.o. Box 197 Channahon IL 60410-5184 Ph: (815) 467-4114 | Gustavo A . Pedraza M.d., Ltd 23952 S Northern Illinois Dr Channahon IL 60410-5184 Ph: (815) 467-4114 |
| NPI Number | 1134451594 |
|---|---|
| Provider Enumeration Date | 02/09/2010 |
| Last Update Date | 02/09/2010 |
| Medicare PECOS PAC ID | 4385788934 |
|---|---|
| Medicare Enrollment ID | O20100219000409 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134451594 | NPI | - | NPPES |
| 982330 | Other | IL | MEDICARE I.D. NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 036076520 (Illinois) | Primary |
| Provider Name | Gustavo A Pedraza |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194811943 PECOS PAC ID: 9931243581 Enrollment ID: I20100219000400 |
Murphy Spine & Sports Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 25158 W Eames St, Unit G, Channahon, IL 60410 Phone: 815-467-4466 Fax: 815-467-4464 | |
Gustavo A. Pedraza, M.d., Ltd. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 25220 S Reed St, Channahon, IL 60410 Phone: 815-467-4114 | |
Uwc- Channahon Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 25407 S Bell Rd Ste A, Channahon, IL 60410 Phone: 312-421-1016 Fax: 815-655-2730 |