Provider Demographics
NPI:1306058854
Name:STREATER, GAIL F (MD/PHD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:F
Last Name:STREATER
Suffix:
Gender:F
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3172
Mailing Address - Country:US
Mailing Address - Phone:309-680-7600
Mailing Address - Fax:309-495-8614
Practice Address - Street 1:320 E ARMSTRONG AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3172
Practice Address - Country:US
Practice Address - Phone:309-495-8671
Practice Address - Fax:309-495-8614
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117673208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117673Medicaid
I73552Medicare UPIN
ILK37923Medicare ID - Type UnspecifiedINDIVIDUAL
IL036117673Medicaid