Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036.142279 | IL |
NPI | 1265871867 |
---|---|
Provider Name | Dr. Akira William Gillingham |
First Address | Chicago, IL 60611-2914 |
Second Address | Chicago, IL 60611-2914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2013 |
Last Update Date | 12/12/2018 |