Basic Information
| Provider Information | |||||||||
| NPI: | 1174954291 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT P GORDON MD SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 S MICHIGAN AVE | ||||||||
| Address2: | SUITE 1300 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606036191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129226067 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Practice Location | |||||||||
| Address1: | 122 S MICHIGAN AVE | ||||||||
| Address2: | SUITE 1300 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606036191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129226067 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2013 | ||||||||
| LastUpdateDate: | 11/30/2013 | ||||||||
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| AuthorizedOfficialLastName: | GORDON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3129226067 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 036049215 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.