Healthcare Provider Details

I. General information

NPI: 1932109998
Provider Name (Legal Business Name): GREGORY T WINTERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 ROYAL BLVD SUITE 300
ELGIN IL
60123-4719
US

IV. Provider business mailing address

2350 ROYAL BLVD SUITE 300
ELGIN IL
60123-4719
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-3120
  • Fax: 847-742-4021
Mailing address:
  • Phone: 847-742-3120
  • Fax: 847-742-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036077502
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: