Active NPI
German Gonzalo, MD
- Family Medicine Physician
- Ottawa, IL
National Provider Identifier
1922487958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- FG2738221
- Practice address
- 30 Oaklane Dr
Ottawa, IL 61350-1135 - Phone
- (815) 488-6232
- NPI assigned
- May 22, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | FG2738221 | IL | Primary |
Addresses
Primary practice location
30 Oaklane Dr
Ottawa, IL 61350-1135
Mailing address
30 Oaklane Dr
Ottawa, IL 61350-1135
Phone (815) 488-6232
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| FG2738221 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432252800000",
"number": "1922487958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 OAKLANE DR",
"city": "OTTAWA",
"state": "IL",
"postal_code": "613501135",
"telephone_number": "815-488-6232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 OAKLANE DR",
"city": "OTTAWA",
"state": "IL",
"postal_code": "613501135",
"telephone_number": "815-488-6232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALO",
"first_name": "GERMAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-05-22",
"last_updated": "2015-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "FG2738221",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ottawa, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.