Healthcare Provider Details

I. General information

NPI: 1831157080
Provider Name (Legal Business Name): FRANK GENTILE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MERCY CRYSTAL LAKE HOSPITAL AND MEDICAL CENTER INC 875 S ROUTE 31
CRYSTAL LAKE IL
60014-8190
US

IV. Provider business mailing address

29624 NETWORK PL
CHICAGO IL
60673-1296
US

V. Phone/Fax

Practice location:
  • Phone: 779-220-5500
  • Fax: 779-220-5184
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036096537
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036096537
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: