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General NPI Number Information
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NPI Number | 1508209867
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Entity Type | Organization
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Legal Business Name | GLOBE FITNESS AND BODYWORK, LLC
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 7353 LAKE ST
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City | RIVER FOREST
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State | IL
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Zip | 60305-2214
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Country | US
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Telephone | 312-307-4458
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Fax |
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Provider Business Mailing Address
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Address Line | 7353 LAKE ST
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City | RIVER FOREST
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State | IL
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Zip | 60305-2214
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Country | US
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Telephone | 312-307-4458
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN GILL
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Credential |
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Telephone | 312-307-4458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 036123466
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License Number State | IL
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