Gustavo a. Pedraza, M.D., LTD.
Organization Active NPI Primary Care Clinic/Center · Channahon, IL
NPI 1275705394 · NPPES record last updated Mar 28, 2008
Key facts
- NPI
- 1275705394
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- GUSTAVO A. PEDRAZA, M.D., LTD.
- Practice address
- 25220 S Reed St
Channahon, IL 60410-6000 - Phone
- (815) 467-4114
- NPI assigned
- Mar 28, 2008
- Organization subpart
- No
Authorized official
- Name
- Gustavo A. Pedraza, M.D.
- Title
- President
- Phone
- (815) 467-4114
Corporate family (same tax ID) 1
Practitioners 1
-
Gustavo A Pedraza, M.D.
National Provider Directory
- Tax ID family
- Gustavo a Pedraza MD LTD
Locations
25220 S Reed St
Channahon, IL 60410
Phone (815) 467-4114
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | IL | Yes |
Addresses
Primary practice location
25220 S Reed St
Channahon, IL 60410-6000
Mailing address
25220 S Reed St
P.O. Box 197
Channahon, IL 60410-6000
Phone (815) 467-4114
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 099-00605 | Other | IL | BLUE CROSS BLUE SHIELD |
Other providers in Channahon, IL
- Elizabeth Ann Glazik
- Danielle Goebel
- Grand Dental Associates, P.C.
- Jennifer Greggain
- Gustavo a . Pedraza M.D., LTD
- Rachel Marie Hamilton
- Stefanie Henline
- Rachel Herzberger
- Randall Scott Highbaugh Jr.
- Lisa Ann Hill
All providers in Channahon, IL · Primary Care Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.