Provider Demographics
NPI:1487605143
Name:LOWELL, GINA S (MD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:S
Last Name:LOWELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:840 S WOOD ST
Mailing Address - Street 2:M/C 856
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-6711
Mailing Address - Fax:312-413-1526
Practice Address - Street 1:840 S WOOD ST
Practice Address - Street 2:M/C 856
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-996-6711
Practice Address - Fax:312-413-1526
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036113137208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113137Medicaid