Provider Demographics
NPI:1558402362
Name:DR GREG GABLIANI LTD
Entity Type:Organization
Organization Name:DR GREG GABLIANI LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:I
Authorized Official - Last Name:GABLIANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-462-3893
Mailing Address - Street 1:2 MEMORIAL DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6723
Mailing Address - Country:US
Mailing Address - Phone:618-462-3893
Mailing Address - Fax:618-462-3894
Practice Address - Street 1:2 MEMORIAL DR
Practice Address - Street 2:SUITE 209
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6723
Practice Address - Country:US
Practice Address - Phone:618-462-3893
Practice Address - Fax:618-462-3894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5143436OtherAETNA
IL101150OtherGHP ADVANTRA
IL2272039OtherCIGNA
IL13464OtherBLUE CROSS OF MISSOURI
ILA12466OtherMERCY
IL101821OtherHEALTHLINK
IL06032003OtherBLUE CROSS OF ILLINOIS
IL25 01550OtherUNITED HEALTHCARE
IL25 01550OtherUNITED HEALTHCARE
ILA12466Medicare UPIN