Provider Demographics
NPI:1992961643
Name:GORDON, CYNTHIA LEE (MD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LEE
Last Name:GORDON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 GRAND AVE STE 390
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4591
Mailing Address - Country:US
Mailing Address - Phone:847-212-1015
Mailing Address - Fax:
Practice Address - Street 1:3320 DUNDEE RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2303
Practice Address - Country:US
Practice Address - Phone:847-892-7910
Practice Address - Fax:847-892-7911
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-0496602084P0800X
IL0361235602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036123560Medicaid
ILF400491295Medicaid