NPIMap

Organization Active NPI

Gabisa Medical Chicago PLLC

  • Primary Care Clinic/Center
  • Chicago, IL
National Provider Identifier
1104563121
Registry record updated May 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
GABISA MEDICAL CHICAGO PLLC
Practice address
3504 N Broadway St
Chicago, IL 60657-1826
Phone
(773) 697-8676
Fax
(888) 929-2371
NPI assigned
May 20, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marcelo Venegas Pizarro, MD
Title
Director
Phone
(347) 524-1914

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

3504 N Broadway St
Chicago, IL 60657-1826

Mailing address

3504 N Broadway St
Chicago, IL 60657-1826
Phone (773) 697-8676

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL mvenegas@knownowhealth.com Direct

National Provider Directory

National Provider Directory
Tax ID family
Gabisa Medical Chicago PLLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3504 N Broadway St
Chicago, IL 60657
Phone (773) 697-8676

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653004800000",
    "number": "1104563121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3504 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606571826",
            "telephone_number": "773-697-8676",
            "fax_number": "888-929-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3504 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606571826",
            "telephone_number": "773-697-8676",
            "fax_number": "888-929-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GABISA MEDICAL CHICAGO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-20",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A",
        "authorized_official_last_name": "VENEGAS PIZARRO",
        "authorized_official_first_name": "MARCELO",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "347-524-1914",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "mvenegas@knownowhealth.com",
            "affiliation": "N",
            "endpointDescription": "encrypted email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3504 N Broadway St",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606571826",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.