Provider Demographics
NPI:1043285026
Name:ROSSEAU, GAIL L (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:L
Last Name:ROSSEAU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4501 N WINCHESTER AVE
Mailing Address - Street 2:3RD FL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-250-0500
Mailing Address - Fax:773-250-0497
Practice Address - Street 1:4501 N WINCHESTER AVE
Practice Address - Street 2:2ND FL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-250-0500
Practice Address - Fax:773-250-0497
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2008-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036 085338207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360853381Medicaid
ILL22326Medicare ID - Type Unspecified
F41311Medicare UPIN
IL0360853381Medicaid