MEDICARE: DENNIS GALLEGOS RN

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	163W00000X	Registered Nurse	041326654	IL

General Provider Information

NPI Number	:	1710815170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS GALLEGOS RN

Provider Business Mailing Address
First Line	:	2710 W BRYN MAWR AVE APT A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4814
Country	:	US
Telephone Number	:	773-878-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	5145 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3661
Country	:	US
Telephone Number	:	773-878-8200
Fax Number	:

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

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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