Healthcare Provider Details

I. General information

NPI: 1669216537
Provider Name (Legal Business Name): GABRIEL VALAGNI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DR
CHICAGO IL
60657-5640
US

IV. Provider business mailing address

350 W OAKDALE AVE APT 1408
CHICAGO IL
60657-5658
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3017
  • Fax:
Mailing address:
  • Phone: 773-872-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.083696
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: