Healthcare Provider Details

I. General information

NPI: 1306938311
Provider Name (Legal Business Name): GURNEE PHYSICAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 LAKEVIEW PKWY SUITE 190
VERNON HILLS IL
60061-1400
US

IV. Provider business mailing address

977 LAKEVIEW PKWY SUITE 190
VERNON HILLS IL
60061-1400
US

V. Phone/Fax

Practice location:
  • Phone: 847-932-1079
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: NEELESH PATEL
Title or Position: OWNER
Credential:
Phone: 847-932-1079