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General NPI Number Information
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NPI Number | 1548484629
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Entity Type | Individual
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Provider Name | GINA M. MIDMORE M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 1275 E BELVIDERE RD SUITE 200
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City | GRAYSLAKE
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State | IL
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Zip | 60030-2082
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Country | US
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Telephone | 847-918-1462
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Fax | 847-968-4311
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Provider Business Mailing Address
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Address Line | 1275 E BELVIDERE RD SUITE 200
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City | GRAYSLAKE
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State | IL
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Zip | 60030-2082
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Country | US
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Telephone | 847-918-1462
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Fax | 847-968-4311
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD433697
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 60516-20
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01073411A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036-131270
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License Number State | IL
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