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NPI Code Detail

MEDICARE: MATTHEW D GIMRE MD

MEDICARE: MATTHEW D GIMRE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QS0010XSports Medicine (Family Medicine) Physician036101771IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01163249OTHERILRR MEDICARE

General Provider Information

NPI Number : 1154310365
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW D GIMRE MD
Provider Business Mailing Address
First Line : 27650 FERRY RD
Second Line : SUITE 100
City : WARRENVILLE
State : IL
Zip : 60555-3845
Country : US
Telephone Number : 630-225-2663
Fax Number : 630-225-2399
Provider Business Practice Location Address
First Line : 27650 FERRY RD
Second Line : SUITE 100
City : WARRENVILLE
State : IL
Zip : 60555-3845
Country : US
Telephone Number : 630-225-2663
Fax Number : 630-225-2399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2005
Last Update Date : 04/01/2014

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