MEDICARE: GILBERT N EGEKEZE 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	036100558	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00192277	OTHER	IL	RAIL ROAD MEDICARE

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
2	04532115	OTHER	IL	BLUE CROSS/SHIELD

General Provider Information

NPI Number	:	1548361959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GILBERT N EGEKEZE MD

Provider Business Mailing Address
First Line	:	5480 ALEXANDRIA DR
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-6211
Country	:	US
Telephone Number	:	815-477-7800
Fax Number	:	815-477-7812

Provider Business Practice Location Address
First Line	:	5911 NORTHWEST HWY
Second Line	:	#205
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-8065
Country	:	US
Telephone Number	:	815-477-7800
Fax Number	:	815-477-7812

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	04/05/2012

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Directions to “ GILBERT N EGEKEZE MD” Practice Location

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