Provider Demographics
NPI:1003038423
Name:GURNSEY, ZACHARIAH (MD)
Entity Type:Individual
Prefix:
First Name:ZACHARIAH
Middle Name:
Last Name:GURNSEY
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 1:751 N RUTLEDGE ST
Mailing Address - Street 2:PO BOX 19636
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-4909
Mailing Address - Country:US
Mailing Address - Phone:217-545-0182
Mailing Address - Fax:217-545-8156
Practice Address - Street 1:751 N RUTLEDGE ST
Practice Address - Street 2:STE 1100
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4909
Practice Address - Country:US
Practice Address - Phone:217-545-0182
Practice Address - Fax:217-545-8156
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-121679207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036121679Medicaid
IL036121679Medicaid