Provider Demographics
NPI:1497824908
Name:GABRIEL, MEHDAT (MD)
Entity Type:Individual
Prefix:
First Name:MEHDAT
Middle Name:
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:LOYOLA UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:MCGAW ENT., RM. 47
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-5221
Mailing Address - Fax:708-216-0899
Practice Address - Street 1:LOYOLA UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:MCGAW ENT., RM. 47
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-5221
Practice Address - Fax:708-216-0899
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-105453207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK24227OtherMEDICARE
ILK24227OtherMEDICARE
H48631Medicare UPIN