Healthcare Provider Details

I. General information

NPI: 1962475939
Provider Name (Legal Business Name): GARY RICHARD FINKELSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W ELM ST
STREATOR IL
61364-2127
US

IV. Provider business mailing address

102 W ELM ST
STREATOR IL
61364-2127
US

V. Phone/Fax

Practice location:
  • Phone: 815-672-4600
  • Fax: 815-672-3333
Mailing address:
  • Phone: 815-672-4600
  • Fax: 815-672-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036073239
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036-073239
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: