Provider Demographics
NPI:1326032426
Name:DOUGLAS GILL MD SC
Entity type:Organization
Organization Name:DOUGLAS GILL MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-850-7522
Mailing Address - Street 1:217 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1525
Mailing Address - Country:US
Mailing Address - Phone:630-850-7520
Mailing Address - Fax:630-850-7514
Practice Address - Street 1:217 55TH ST
Practice Address - Street 2:
Practice Address - City:CLARENDON HLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1525
Practice Address - Country:US
Practice Address - Phone:630-850-7520
Practice Address - Fax:630-850-7514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02201586OtherBCBS
IL02201586OtherBCBS
D16053Medicare UPIN