Provider Demographics
NPI:1417907031
Name:GINDI, MARY Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:Y
Last Name:GINDI
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 1:511 W FAIRCHILD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3801
Mailing Address - Country:US
Mailing Address - Phone:217-431-2025
Mailing Address - Fax:217-431-0014
Practice Address - Street 1:511 W FAIRCHILD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3801
Practice Address - Country:US
Practice Address - Phone:217-431-2025
Practice Address - Fax:217-431-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36100736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371404796001Medicaid
IL171041OtherPERSONAL CARE
IL371404796002Medicaid
IL036100736Medicaid
IL09232019OtherBLUE CROSS BLUE SHIELD
IL060657OtherHEALTH ALLIANCE
IL09232019OtherBLUE CROSS BLUE SHIELD
IL080163505Medicare PIN
IL171041OtherPERSONAL CARE
ILL85282Medicare PIN