Healthcare Provider Details

I. General information

NPI: 1326076654
Provider Name (Legal Business Name): DAVID GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 CONWAY CIR
BLOOMINGTON IL
61704-8285
US

IV. Provider business mailing address

24 CONWAY CIR
BLOOMINGTON IL
61704-8285
US

V. Phone/Fax

Practice location:
  • Phone: 217-621-8720
  • Fax:
Mailing address:
  • Phone: 217-621-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number036-081795
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-081795
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: