Healthcare Provider Details

I. General information

NPI: 1477549590
Provider Name (Legal Business Name): JAMES LEO GILDNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 N RUTLEDGE ST BAYLIS BUILDING, 2ND FLOOR
SPRINGFIELD IL
62702-6700
US

IV. Provider business mailing address

747 N RUTLEDGE ST BAYLIS BUILDING, 2ND FLOOR
SPRINGFIELD IL
62702-6700
US

V. Phone/Fax

Practice location:
  • Phone: 217-757-7491
  • Fax: 217-757-7920
Mailing address:
  • Phone: 217-757-7491
  • Fax: 217-757-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: