Provider Demographics
NPI:1003025891
Name:GERARDI, WILLIAM EDMOND (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDMOND
Last Name:GERARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 N LAKE SHORE DRIVE
Mailing Address - Street 2:APARTMENT 2A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4204
Mailing Address - Country:US
Mailing Address - Phone:773-244-3060
Mailing Address - Fax:
Practice Address - Street 1:3730 N LAKE SHORE DR
Practice Address - Street 2:APARTMENT 2A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4204
Practice Address - Country:US
Practice Address - Phone:773-244-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42730207R00000X
FLME75755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine