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General NPI Number Information
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NPI Number | 1548764236
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Entity Type | Individual
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Provider Name | ANDREW M GAILLARDETZ MD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 1414 CROSS ST STE 210
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City | SHILOH
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State | IL
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Zip | 62269-2941
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Country | US
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Telephone | 618-767-7000
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Fax | 618-624-4865
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Provider Business Mailing Address
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Address Line | 1414 CROSS ST STE 210
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City | SHILOH
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State | IL
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Zip | 62269-2941
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Country | US
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Telephone | 186-767-7000
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Fax | 618-624-4865
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036155817
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.155817
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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