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1881965309
GORDON ANDREW FUQUA
CHICAGO, IL
NPI
1881965309
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2084P0800X Psychiatry & Neurology, Psychiatry
(Licence: IL 036041997)
Enumeration Date
2012-01-13
Last Update Date
2012-01-13
Business Address
Dr. GORDON ANDREW FUQUA M.D.
2131 N CLARK ST # 9
CHICAGO, IL 60614-6188
Phone number: 312-623-8006
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Mailing Address
Dr. GORDON ANDREW FUQUA M.D.
2131 N CLARK ST # 9
CHICAGO, IL 60614-6188
Phone number: 312-623-8006
Copy
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