Provider Demographics
NPI:1174728430
Name:GOMEZ, MARK D (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:120 SPALDING DR STE 303
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6557
Mailing Address - Country:US
Mailing Address - Phone:630-527-5576
Mailing Address - Fax:630-527-5573
Practice Address - Street 1:120 SPALDING DR STE 303
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6557
Practice Address - Country:US
Practice Address - Phone:630-527-5576
Practice Address - Fax:630-527-5573
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36118614207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1174728430OtherINTERNAL MEDICINE
IL9919630OtherBCBS
IL036118614 1Medicaid
ILK40570Medicare PIN