MEDICARE: GI PARTNERS OF ILLINOIS, PLLC

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	207RG0100X	Gastroenterology Physician

General Provider Information

NPI Number	:	1548613995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GI PARTNERS OF ILLINOIS, PLLC

Provider Business Mailing Address
First Line	:	1880 W WINCHESTER RD STE 201
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-5336
Country	:	US
Telephone Number	:	847-247-0187
Fax Number	:	847-247-0487

Provider Business Practice Location Address
First Line	:	1880 W WINCHESTER RD
Second Line	:	#201
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-5341
Country	:	US
Telephone Number	:	847-247-0187
Fax Number	:	847-247-0487

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	EVELINA WISNIEWSKI
Credential	:
Telephone Number	:	773-407-4443

Provider Enumeration Date	:	07/21/2016
Last Update Date	:	06/02/2026

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