Provider Demographics
NPI:1154577823
Name:GENT, JUSTIN J (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:J
Last Name:GENT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:900 RAND RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2359
Mailing Address - Country:US
Mailing Address - Phone:847-324-3976
Mailing Address - Fax:847-929-1154
Practice Address - Street 1:406 FRONT ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5593
Practice Address - Country:US
Practice Address - Phone:847-381-0388
Practice Address - Fax:847-381-0811
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036123247207XX0005X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036123247Medicaid
IL036123247OtherSTATE LICENSE