Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036152733 | IL |
N | 207Q00000X | Family Doctor | 125071506 | IL |
NPI | 1003337817 |
---|---|
Provider Name | Dr. Gabrielle Denise Gay |
First Address | Chicago, IL 60644-2342 |
Second Address | Chicago, IL 60644-2342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2017 |
Last Update Date | 06/08/2020 |