Provider Demographics
NPI:1598767741
Name:VAN WINGERDEN DONS, GAIL I (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:I
Last Name:VAN WINGERDEN DONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GAIL
Other - Middle Name:I
Other - Last Name:VAN WINGERDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5617 S DORCHESTER AVE
Mailing Address - Street 2:4N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637
Mailing Address - Country:US
Mailing Address - Phone:210-710-5467
Mailing Address - Fax:
Practice Address - Street 1:5617 S DORCHESTER AVE
Practice Address - Street 2:4N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:210-710-5467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.051371207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114624302Medicaid
TX114624302Medicaid
TXE50647Medicare UPIN