Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036123247 | IL |
NPI | 1154577823 |
---|---|
Provider Name | Dr. Justin J Gent |
First Address | Des Plaines, IL 60016-2359 |
Second Address | Mchenry, IL 60050-5593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2008 |
Last Update Date | 23/12/2021 |