Provider Demographics
NPI:1730236035
Name:GOMEZ, ANGEL (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:GOMEZ-GALAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1600 N RANDALL RD STE 115
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7804
Mailing Address - Country:US
Mailing Address - Phone:224-856-2300
Mailing Address - Fax:248-562-3052
Practice Address - Street 1:1600 N RANDALL RD STE 115
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7804
Practice Address - Country:US
Practice Address - Phone:224-856-2300
Practice Address - Fax:224-856-2305
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066870Medicaid
ILB44619Medicare UPIN
IL036066870Medicaid