Colette B. Gordon MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036052490 Issued in IL

Legal business name

COLETTE B. GORDON MD

Practice address

2800 N Sheridan Rd Ste 101
Chicago, IL 60657-6162

Phone

(773) 281-7835

Fax

(773) 281-8736

NPI assigned

Jan 15, 2008

Last updated

Feb 14, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Titi B Thach

Title

Biller

Phone

(773) 281-7835

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Colette Gordon, MD

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1447266176
  NPD (past)

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

{
    "created_epoch": "1200355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202947200000",
    "number": "1689850166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 N SHERIDAN RD STE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576162",
            "telephone_number": "773-281-7835",
            "fax_number": "773-281-8736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 N SHERIDAN RD STE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606576162",
            "telephone_number": "773-281-7835",
            "fax_number": "773-281-8736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLETTE B. GORDON MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-15",
        "last_updated": "2008-02-14",
        "status": "A",
        "authorized_official_last_name": "THACH",
        "authorized_official_first_name": "TITI",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "773-281-7835"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036052490",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036052490",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Coler Chiropractic Center PC
• Joseph Gerad Coler, D.O.
• Wendi Coler, D.O.
• Coles SLF, LLC
• Coles Supportive Living
• Ariana Coletti, DC
• Raymond Coley, LCPC
• Brendan Colgan, MD
• Jennifer Yvonne Colgan, M.D.
• Carolyn Coli

• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2008; 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.