Provider Demographics
NPI:1417060120
Name:GIOLAS, DALE J (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:J
Last Name:GIOLAS
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 1:550 FOX GLEN CT
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1833
Mailing Address - Country:US
Mailing Address - Phone:847-381-8170
Mailing Address - Fax:847-381-8359
Practice Address - Street 1:550 FOX GLEN CT
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1833
Practice Address - Country:US
Practice Address - Phone:847-381-8170
Practice Address - Fax:847-381-8359
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL551710Medicare ID - Type UnspecifiedBILLING CODE
ILE18558Medicare UPIN