Provider Demographics
NPI:1437247673
Name:GABRIEL, DANTE POLINTAN (MD)
Entity Type:Individual
Prefix:MR
First Name:DANTE
Middle Name:POLINTAN
Last Name:GABRIEL
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 1:15 TOWER CT
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-623-4464
Mailing Address - Fax:847-623-9984
Practice Address - Street 1:15 TOWER CT
Practice Address - Street 2:SUITE 150
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-623-4464
Practice Address - Fax:847-623-9984
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046907208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046907Medicaid