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General NPI Number Information
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NPI Number | 1972215390
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Entity Type | Organization
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Legal Business Name | GGL HEALTHCARE ASSOCIATES, PLLC
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Dates
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Enumeration Date | 12/16/2022
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 9933 LAWLER AVE STE 440
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City | SKOKIE
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State | IL
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Zip | 60077-3720
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Country | US
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Telephone | 847-529-5332
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Fax |
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Provider Business Mailing Address
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Address Line | 342 S MILWAUKEE AVE
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City | WHEELING
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State | IL
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Zip | 60090-5021
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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 | OFFICER
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Name | BORIS GUREVICH
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Credential | MD
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Telephone | 847-226-5503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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