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General NPI Number Information
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NPI Number | 1720187453
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Entity Type | Individual
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Provider Name | PATRICK GERARD GANNON DO
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 626 BETHANY RD 3251 COMMERCE DRIVE
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City | DEKALB
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State | IL
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Zip | 60115-4939
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Country | US
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Telephone | 815-756-1521
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Fax |
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Provider Business Mailing Address
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Address Line | 2807 BRITTANY CT
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City | ST CHARLES
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State | IL
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Zip | 60175-5161
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Country | US
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Telephone |
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | IL
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