Provider Demographics
NPI:1629245717
Name:RICHARD A GELINE M.D.S.C
Entity Type:Organization
Organization Name:RICHARD A GELINE M.D.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GELINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-729-9088
Mailing Address - Street 1:1225 CENTRAL RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4349
Mailing Address - Country:US
Mailing Address - Phone:847-729-9088
Mailing Address - Fax:
Practice Address - Street 1:1225 CENTRAL RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-4349
Practice Address - Country:US
Practice Address - Phone:847-729-9088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036040714207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036040714Medicaid
IL036040714Medicaid