Provider Demographics
NPI:1003863077
Name:GUELICH, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:GUELICH
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 1:3000 HALSTED STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9269
Mailing Address - Country:US
Mailing Address - Phone:773-433-3130
Mailing Address - Fax:
Practice Address - Street 1:3000 HALSTED STREET
Practice Address - Street 2:SUITE 525
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9269
Practice Address - Country:US
Practice Address - Phone:773-443-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110068207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110068Medicaid
ILP00361976OtherRAILROAD MEDICARE
ILK28583Medicare PIN
I54649Medicare UPIN