Provider Demographics
NPI:1891876934
Name:GATES, KHALILAH LATRECE (MD)
Entity type:Individual
Prefix:DR
First Name:KHALILAH
Middle Name:LATRECE
Last Name:GATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST STE 18-250
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5980
Mailing Address - Country:US
Mailing Address - Phone:312-695-1800
Mailing Address - Fax:312-695-4741
Practice Address - Street 1:675 N SAINT CLAIR ST STE 18-250
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5980
Practice Address - Country:US
Practice Address - Phone:312-695-1800
Practice Address - Fax:312-695-4741
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine