Provider Demographics
NPI:1164597555
Name:FORCIER, GARY L (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:FORCIER
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 1:800 BIESTERFIELD ROAD
Mailing Address - Street 2:#106 WIMMER MEDICAL PLAZA
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007
Mailing Address - Country:US
Mailing Address - Phone:847-981-8866
Mailing Address - Fax:847-981-5580
Practice Address - Street 1:800 BIESTERFIELD ROAD
Practice Address - Street 2:#106 WIMMER MEDICAL PLAZA
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007
Practice Address - Country:US
Practice Address - Phone:847-981-8866
Practice Address - Fax:847-981-5580
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064543207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064543Medicaid
C41380Medicare UPIN
ILL11734Medicare ID - Type Unspecified