Healthcare Provider Details

I. General information

NPI: 1588054647
Provider Name (Legal Business Name): BRANDON C. GIMBEL, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 11/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SKOKIE BLVD SUITE 1A
NORTHBROOK IL
60062
US

IV. Provider business mailing address

601 SKOKIE BLVD SUITE 1A
NORTHBROOK IL
60062
US

V. Phone/Fax

Practice location:
  • Phone: 847-892-7300
  • Fax: 847-892-7301
Mailing address:
  • Phone: 847-892-7300
  • Fax: 847-892-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036131722
License Number StateIL

VIII. Authorized Official

Name: DR. BRANDON GIMBEL
Title or Position: OWNER
Credential: M.D.
Phone: 847-892-7300