1154308518 NPI number — INSIGHT CHICAGO, INC.

Table of content: DAVID HENRY GONZALES LCSW (NPI 1477786267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154308518 NPI number — INSIGHT CHICAGO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHT CHICAGO, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154308518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776473
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-2333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-567-2000
Provider Business Mailing Address Fax Number:
312-638-8320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 S MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60616-2333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-567-2000
Provider Business Practice Location Address Fax Number:
312-567-6156
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COLE
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
810-275-9333

Provider Taxonomy Codes

  • Taxonomy code: 273Y00000X , with the licence number:  362170152 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00035 . This is a "BCBSIL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 362170152004 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 362170152001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006247 . This is a "STATE OF ILLINOIS LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 11727 . This is a "CITY OF CHICAGO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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