Healthcare Provider Details

I. General information

NPI: 1346944980
Provider Name (Legal Business Name): GREGORY FRANCIS GILDEA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 WEST TALCOTT AVE RESURRECTION FAMILY MEDICINE, STE. 182
CHICAGO IL
60631
US

IV. Provider business mailing address

7447 WEST TALCOTT AVE RESURRECTION FAMILY MEDICINE, STE. 182
CHICAGO IL
60631
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-5155
  • Fax:
Mailing address:
  • Phone: 773-792-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.081687
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: