Provider Demographics
NPI:1114901675
Name:SLADEK, GARY GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:GEORGE
Last Name:SLADEK
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 1:411 CLARIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-5076
Mailing Address - Country:US
Mailing Address - Phone:847-356-3471
Mailing Address - Fax:
Practice Address - Street 1:3001A 6TH ST
Practice Address - Street 2:NAVAL HOSPITAL GREAT LAKES
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-5230
Practice Address - Country:US
Practice Address - Phone:847-688-4560
Practice Address - Fax:847-688-2678
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine