Provider Demographics
NPI:1578540795
Name:DILLEHAY, GARY L (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:DILLEHAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:251 E HURON ST
Mailing Address - Street 2:NUCLEAR MEDICINE, GALTER 8-110
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2908
Mailing Address - Country:US
Mailing Address - Phone:312-926-5119
Mailing Address - Fax:708-216-9033
Practice Address - Street 1:251 E HURON ST
Practice Address - Street 2:NUCLEAR MEDICINE, GALTER 8-110
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-5119
Practice Address - Fax:708-216-9033
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL360610302085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36061030Medicaid
IL367030Medicare ID - Type Unspecified
IL36061030Medicaid