Provider Demographics
NPI:1528118510
Name:GENTILE, SHEILLAH C (MD)
Entity type:Individual
Prefix:DR
First Name:SHEILLAH
Middle Name:C
Last Name:GENTILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1234
Mailing Address - Country:US
Mailing Address - Phone:219-865-9160
Mailing Address - Fax:219-865-9251
Practice Address - Street 1:1001 MAIN ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1234
Practice Address - Country:US
Practice Address - Phone:219-865-9160
Practice Address - Fax:219-865-9251
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01050311A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01050311AOtherSTATE LISCENSE
IL90001143OtherBC BS OF IL
IL90001143OtherBC BS OF IL
H10660Medicare UPIN
IN217610CMedicare ID - Type Unspecified
IN01050311AOtherSTATE LISCENSE