Healthcare Provider Details

I. General information

NPI: 1811993470
Provider Name (Legal Business Name): JULIE A GILBERTSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 N. WOLF RD
MOUNT PROSPECT IL
60056
US

IV. Provider business mailing address

1329 N. WOLF RD
MOUNT PROSPECT IL
60056
US

V. Phone/Fax

Practice location:
  • Phone: 847-803-3040
  • Fax: 847-803-0871
Mailing address:
  • Phone: 847-803-3040
  • Fax: 847-803-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036079589
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: