Individual provider Active NPI

Armand A Gonzalzles, M.D.

  • Pediatrics Physician
  • Chicago, IL
National Provider Identifier
1104823228
Registry record updated Apr 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036052969 Issued in IL
Practice address
2045 W. Washington Blvd
M/C 698
Chicago, IL 60612-2428
Phone
(312) 996-2000
Fax
(312) 413-7812
NPI assigned
Jul 5, 2005
Reactivated
Apr 6, 2006
Last updated
Apr 28, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036052969 IL Primary

Addresses

Primary practice location

2045 W. Washington Blvd
M/C 698
Chicago, IL 60612-2428

Mailing address

2045 W. Washington Blvd
M/C 698
Chicago, IL 60612-2428
Phone (312) 996-2000

Other identifiers 1

IdentifierTypeStateIssuer
036052969MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036052969ILMDPediatrics Physician

NPI Registry JSON

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303948800000",
    "number": "1104823228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 W. WASHINGTON BLVD",
            "address_2": "M/C 698",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606122428",
            "telephone_number": "312-996-2000",
            "fax_number": "312-413-7812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 W. WASHINGTON BLVD",
            "address_2": "M/C 698",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606122428",
            "telephone_number": "312-996-2000",
            "fax_number": "312-413-7812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALZLES",
        "first_name": "ARMAND",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-05",
        "last_updated": "2011-04-28",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036052969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036052969",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.