Provider Demographics
NPI:1962566125
Name:WILLER, GARY ALAN
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:WILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:WILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:30 N MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3746
Mailing Address - Country:US
Mailing Address - Phone:312-263-0004
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVENUE
Practice Address - Street 2:SUITE 1104
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3746
Practice Address - Country:US
Practice Address - Phone:312-263-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31600468OtherBLUE CROSS BLUE SHIELD
IL31600468OtherBLUE CROSS BLUE SHIELD