MEDICARE: GAIL J GIZZO-WAITLEY 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
1	207R00000X	Internal Medicine Physician	036092533	IL
2	208M00000X	Hospitalist Physician	036092533	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CA4748	OTHER	IL	MEDICARE RAILROAD (GROUP)
4	P01258419	OTHER	IL	MEDICARE RAILROAD (INDIVIDUAL)
5	206147	OTHER	IL	MEDICARE PTAN (GROUP)
6	206147242	OTHER	IL	MEDICARE PTAN (INDIVIDUAL)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9919630	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1518954270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL J GIZZO-WAITLEY MD

Provider Business Mailing Address
First Line	:	25 N WINFIELD RD
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1295
Country	:	US
Telephone Number	:	630-933-4700
Fax Number	:	630-933-4427

Provider Business Practice Location Address
First Line	:	25 N. WINFIELD
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1295
Country	:	US
Telephone Number	:	630-933-4700
Fax Number	:	630-933-4427

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2005
Last Update Date	:	01/18/2018

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Directions to “ GAIL J GIZZO-WAITLEY MD” Practice Location

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