Healthcare Provider Details

I. General information

NPI: 1154577823
Provider Name (Legal Business Name): JUSTIN GENT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 FRONT ST
MCHENRY IL
60050-5593
US

IV. Provider business mailing address

250 S NORTHWEST HWY STE 200
PARK RIDGE IL
60068-4252
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-0388
  • Fax: 847-381-0811
Mailing address:
  • Phone: 847-324-3976
  • Fax: 847-929-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036-123247
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: