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NPI Code Detail

MEDICARE: GARY L DILLEHAY MD

MEDICARE: GARY L DILLEHAY 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
12085N0904XNuclear Radiology Physician36061030IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578540795
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY L DILLEHAY MD
Provider Business Mailing Address
First Line : 251 E HURON ST
Second Line : NUCLEAR MEDICINE, GALTER 8-110
City : CHICAGO
State : IL
Zip : 60611-2908
Country : US
Telephone Number : 312-926-5119
Fax Number : 708-216-9033
Provider Business Practice Location Address
First Line : 251 E HURON ST
Second Line : NUCLEAR MEDICINE, GALTER 8-110
City : CHICAGO
State : IL
Zip : 60611-2908
Country : US
Telephone Number : 312-926-5119
Fax Number : 708-216-9033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 04/04/2012

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