Healthcare Provider Details

I. General information

NPI: 1053009357
Provider Name (Legal Business Name): GEORGE GEROLIMATOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 FRANKLIN AVE
NORMAL IL
61761-3558
US

IV. Provider business mailing address

13 S WYNSTONE DR
NORTH BARRINGTON IL
60010-6936
US

V. Phone/Fax

Practice location:
  • Phone: 309-268-3558
  • Fax:
Mailing address:
  • Phone: 847-651-8472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.081368
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: