Provider Demographics
NPI:1558519454
Name:GIMBEL, DEVON COLLINS (MD)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:COLLINS
Last Name:GIMBEL
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 1:28100 N ASHLEY CIR
Mailing Address - Street 2:STE 106
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-9478
Mailing Address - Country:US
Mailing Address - Phone:847-996-1030
Mailing Address - Fax:
Practice Address - Street 1:28100 N ASHLEY CIR
Practice Address - Street 2:STE 106
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-9478
Practice Address - Country:US
Practice Address - Phone:847-996-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA246366207ZD0900X
WI61611-20207ZD0900X
IL036.130826207ZD0900X, 207ZP0101X
IN01073424A207ZD0900X
MAL-236414207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology