Provider Demographics
NPI:1164263349
Name:DA SILVA BORBA, GUSTAVO (MD)
Entity type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:
Last Name:DA SILVA BORBA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1461 SOUTH BLUE ISLAND AVENUE
Mailing Address - Street 2:APT 616
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2293
Mailing Address - Country:US
Mailing Address - Phone:773-257-5701
Mailing Address - Fax:773-257-6027
Practice Address - Street 1:1500 SOUTH FAIRFIELD AVENUE
Practice Address - Street 2:SUITE F-908
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1782
Practice Address - Country:US
Practice Address - Phone:773-257-5701
Practice Address - Fax:773-257-6027
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL125.083568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine