Provider Demographics
NPI:1992903850
Name:BASCH, GAIL M (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:M
Last Name:BASCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2150 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3706
Mailing Address - Country:US
Mailing Address - Phone:312-942-5375
Mailing Address - Fax:312-942-3113
Practice Address - Street 1:2150 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3706
Practice Address - Country:US
Practice Address - Phone:312-942-5375
Practice Address - Fax:312-942-3113
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-0817142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF30165Medicare UPIN