Healthcare Provider Details

I. General information

NPI: 1992905970
Provider Name (Legal Business Name): PAUL R GULLO AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PAUL RUSSELL GULLO AUD

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20527 S LAGRANGE RD
FRANKFORT IL
60423-1345
US

IV. Provider business mailing address

20527 S LAGRANGE RD
FRANKFORT IL
60423-1345
US

V. Phone/Fax

Practice location:
  • Phone: 312-305-6500
  • Fax: 312-305-6500
Mailing address:
  • Phone: 312-305-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number81586
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number81586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: