Gordon, Michael

Gordon, Michael is an individual health care provider with primary practice located at 659 E Jefferson St , Freeport IL 61032-6027. He recently has only one registered license in Other Service Providers / Community Health Worker, which is considered as his primary health care specialty. Gordon, Michael can be contacted via phone (815) 229-1999.

Contact Information

Primary practice address
659 E Jefferson St Freeport IL 61032-6027
Phone: (815) 229-1999
Fax: (708) 478-6387
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Community Health Worker 172V00000X ADS1101002 Illinois

Profile Details

NPI number 1275981805
LBN Legal business name Gordon, Michael
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2016
Last updated May 24th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275981805 NPPES
Illinois Other ADS1101002 ILLINOIS DEPARTENT OF AGING

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