Provider Demographics
NPI:1588740591
Name:GERTZEN, JOYCE (MD)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:GERTZEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JO
Other - Middle Name:
Other - Last Name:GERTZEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1608 W BERWYN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2006
Mailing Address - Country:US
Mailing Address - Phone:773-728-9678
Mailing Address - Fax:708-633-4136
Practice Address - Street 1:15900 SOUTH CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-4006
Practice Address - Country:US
Practice Address - Phone:708-687-7200
Practice Address - Fax:708-633-4136
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE33651Medicare UPIN