Provider Demographics
NPI:1164957395
Name:FUCHS, GABRIELLA (MD)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:FUCHS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 E RIVERSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-2300
Mailing Address - Country:US
Mailing Address - Phone:815-971-7000
Mailing Address - Fax:815-968-7830
Practice Address - Street 1:8201 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-2300
Practice Address - Country:US
Practice Address - Phone:815-971-7000
Practice Address - Fax:815-968-7830
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2023-11-30
Deactivation Date:2017-11-27
Deactivation Code:
Reactivation Date:2017-11-29
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL36.153045208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program