Provider Demographics
NPI:1558337840
Name:OZARK, GREGORY JERARD (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JERARD
Last Name:OZARK
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 1:2160 S 1ST AVE
Mailing Address - Street 2:(7511 LEMONT RD, DARIEN, IL. 60561)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:630-985-4989
Mailing Address - Fax:630-985-4540
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:(7511 LEMONT RD, DARIEN, IL. 60561)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:630-985-4989
Practice Address - Fax:630-985-4540
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36094072208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36094072Medicaid
IL36094072Medicaid