Healthcare Provider Details

I. General information

NPI: 1285821868
Provider Name (Legal Business Name): GABRIEL LEMUS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13415 S ROUTE 59
PLAINFIELD IL
60585-5676
US

IV. Provider business mailing address

13415 S ROUTE 59
PLAINFIELD IL
60585-5676
US

V. Phone/Fax

Practice location:
  • Phone: 815-609-3627
  • Fax:
Mailing address:
  • Phone: 815-609-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209006782
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: