Provider Demographics
NPI:1275527319
Name:GINDORF, JEFFREY DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DEAN
Last Name:GINDORF
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 1:600 S RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5935
Mailing Address - Country:US
Mailing Address - Phone:847-658-4793
Mailing Address - Fax:815-261-5964
Practice Address - Street 1:600 S RANDALL RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5935
Practice Address - Country:US
Practice Address - Phone:847-658-4793
Practice Address - Fax:815-261-5964
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078574Medicaid
IL036078574Medicaid
ILL92340Medicare PIN