Provider Demographics
NPI:1407296270
Name:PODOLEJ, GREGORY STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STANLEY
Last Name:PODOLEJ
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 1:1000 E 53RD ST
Mailing Address - Street 2:UNIT 513 S.
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4369
Mailing Address - Country:US
Mailing Address - Phone:847-714-4123
Mailing Address - Fax:
Practice Address - Street 1:5841 S. MARYLAND AVE. MC 5068
Practice Address - Street 2:UNIVERSITY OF CHICAGO, SECTION OF EMERGENCY MEDICINE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-702-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-062641207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine