MEDICARE: NICOLE M GENTILE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	55286	MN
2	207R00000X	Internal Medicine Physician	036.134432	IL
3	207RG0100X	Gastroenterology Physician	036.134432	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417241944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE M GENTILE MD

Provider Business Mailing Address
First Line	:	22285 N PEPPER RD STE 311
Second Line	:
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-2541
Country	:	US
Telephone Number	:	847-382-4410
Fax Number	:	815-968-9453

Provider Business Practice Location Address
First Line	:	22285 N PEPPER RD STE 311
Second Line	:
City	:	LAKE BARRINGTON
State	:	IL
Zip	:	60010-2541
Country	:	US
Telephone Number	:	847-382-4410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2011
Last Update Date	:	09/28/2020

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Directions to “ NICOLE M GENTILE MD” Practice Location

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