Healthcare Provider Details

I. General information

NPI: 1992031751
Provider Name (Legal Business Name): STEVE M GILLANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E WACKER DR LL02
CHICAGO IL
60601-3713
US

IV. Provider business mailing address

111 E WACKER DR LL02
CHICAGO IL
60601-3713
US

V. Phone/Fax

Practice location:
  • Phone: 312-861-1953
  • Fax: 312-861-1955
Mailing address:
  • Phone: 312-861-1953
  • Fax: 312-861-1955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberG45079364078
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: