Michael Edward Gordon, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1916382 Issued in IL

Practice address

635 Chicago Ave
Evanston, IL 60202

Phone

(847) 491-0880

Fax

(847) 491-0014

NPI assigned

May 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449014400000",
    "number": "1821042433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1841 W 47TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606093844",
            "telephone_number": "847-491-0880",
            "fax_number": "847-491-0014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 CHICAGO AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "60202",
            "telephone_number": "847-491-0880",
            "fax_number": "847-491-0014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "MICHAEL",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2015-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "1916382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Goodman, CPNP
• Rebecca Joy Goodman
• Carin R Gordon, M.D.
• Carol Evelyn Gordon, LCSW
• Lisa Beth Gordon, PHD
• Rana Gordon, PHD
• Robert A. Gordon, MD
• William Edward Gordon, D.D.S
• Margaret Dembo Gore, MD
• Richard Michael Gore, MD

• General Practice Dentistry in Evanston, IL
• Providers in Evanston, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.