Provider Demographics
NPI:1154310365
Name:GIMRE, MATTHEW D (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:GIMRE
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 1:27650 FERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3845
Mailing Address - Country:US
Mailing Address - Phone:630-225-2663
Mailing Address - Fax:630-225-2399
Practice Address - Street 1:27650 FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3845
Practice Address - Country:US
Practice Address - Phone:630-225-2663
Practice Address - Fax:630-225-2399
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036101771207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01163249OtherRR MEDICARE
IL206147199Medicare PIN
ILH39766Medicare UPIN