Provider Demographics
NPI:1518954270
Name:GIZZO-WAITLEY, GAIL J (MD)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:J
Last Name:GIZZO-WAITLEY
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 1:25 N WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-933-4700
Mailing Address - Fax:630-933-4427
Practice Address - Street 1:25 N. WINFIELD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-933-4700
Practice Address - Fax:630-933-4427
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092533207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092533 2Medicaid
ILCA4748OtherMEDICARE RAILROAD (GROUP)
IL9919630OtherBCBS
ILP01258419OtherMEDICARE RAILROAD (INDIVIDUAL)
IL206147OtherMEDICARE PTAN (GROUP)
IL206147242OtherMEDICARE PTAN (INDIVIDUAL)
ILP01258419OtherMEDICARE RAILROAD (INDIVIDUAL)
IL206147242OtherMEDICARE PTAN (INDIVIDUAL)
ILL96292Medicare PIN