Active NPI
Gabisa Medical Chicago PLLC
- Community Health Clinic/Center
- Chicago, IL
National Provider Identifier
1821765140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Clinic/Center
- Legal business name
- GABISA MEDICAL CHICAGO PLLC
- Practice address
- 4121 W North Ave
Chicago, IL 60639-5205 - Phone
- (773) 697-8623
- Fax
- (888) 929-2371
- NPI assigned
- Aug 25, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Marcelo Venegas-Pizarro, MD
- Title
- Medical Director
- Phone
- (347) 524-1914
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | Primary |
Addresses
Primary practice location
4121 W North Ave
Chicago, IL 60639-5205
Mailing address
3436 Clinton Ave
Berwyn, IL 60402-3322
Phone (347) 524-1914
National Provider Directory
National Provider Directory- Tax ID family
- Gabisa Medical Chicago PLLC
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Primary Care Clinic/Center
- Chicago, IL
- NPI 1104563121
-
- Primary Care Clinic/Center
- Chicago, IL
- NPI 1922745942
-
- Community Health Clinic/Center
- Chicago, IL
- NPI 1952991838
Locations
4121 W North Ave
Chicago, IL 60639
Phone (773) 697-8623
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629849600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1629849600000",
"number": "1821765140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3436 CLINTON AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023322",
"telephone_number": "347-524-1914",
"fax_number": "888-929-2371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4121 W NORTH AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606395205",
"telephone_number": "773-697-8623",
"fax_number": "888-929-2371"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GABISA MEDICAL CHICAGO PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-08-25",
"last_updated": "2021-08-25",
"certification_date": "2021-08-25",
"status": "A",
"authorized_official_last_name": "VENEGAS-PIZARRO",
"authorized_official_first_name": "MARCELO",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "347-524-1914",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "261QC1500X",
"taxonomy_group": "",
"desc": "Clinic/Center, Community Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.