Provider Demographics
NPI:1467448969
Name:GEPHART, TODD A (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:GEPHART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:1141 EAST MAIN STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:EAST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-1642
Practice Address - Country:US
Practice Address - Phone:847-428-3322
Practice Address - Fax:847-428-0472
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-095773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG69149Medicare UPIN