Provider Demographics
NPI:1427057298
Name:GAY, ROBERT L III (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:GAY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N COLUMBUS DR
Mailing Address - Street 2:UNIT 6005
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7910
Mailing Address - Country:US
Mailing Address - Phone:630-853-8388
Mailing Address - Fax:
Practice Address - Street 1:1 E ERIE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2740
Practice Address - Country:US
Practice Address - Phone:312-649-3939
Practice Address - Fax:312-649-5747
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2024-09-17
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
CAG184019207L00000X
IL036085978207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085978Medicaid
ILF88532Medicare UPIN
ILK44315Medicare PIN
IL207812Medicare ID - Type Unspecified