Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036-085091 | IL |
NPI | 1003830670 |
---|---|
Provider Name | Dr. Rhonda Yvette Gans |
First Address | Chicago, IL 60611-4352 |
Second Address | Chicago, IL 60615-1600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 23/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-085094 | (05) | IL |
11373711 | CAQH (01) | IL |
BG3472432 | DEA (01) | IL |
F61861 | (02) | IL |