Healthcare Provider Details

I. General information

NPI: 1043907942
Provider Name (Legal Business Name): GAGE WINTERS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 BARRON BLVD
GRAYSLAKE IL
60030-1330
US

IV. Provider business mailing address

34079 N SOUTH CIRCLE DR
GRAYSLAKE IL
60030-1001
US

V. Phone/Fax

Practice location:
  • Phone: 847-223-4000
  • Fax:
Mailing address:
  • Phone: 847-989-7261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number135001209
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016006158
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number135001209
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: