Healthcare Provider Details

I. General information

NPI: 1538788591
Provider Name (Legal Business Name): GABRIEL SABBAJ SPIELER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4058 W 63RD ST
CHICAGO IL
60629-4639
US

IV. Provider business mailing address

4058 W 63RD ST
CHICAGO IL
60629-4639
US

V. Phone/Fax

Practice location:
  • Phone: 773-584-6200
  • Fax: 844-285-1003
Mailing address:
  • Phone: 773-584-6200
  • Fax: 844-285-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67792
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD481660
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.173983
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: