Provider Demographics
NPI:1689685653
Name:GARMON, GWENN E (MD)
Entity Type:Individual
Prefix:DR
First Name:GWENN
Middle Name:E
Last Name:GARMON
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 1:820 DAMEN
Mailing Address - Street 2:11F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60546
Mailing Address - Country:US
Mailing Address - Phone:312-569-7354
Mailing Address - Fax:312-569-7522
Practice Address - Street 1:820 DAMEN
Practice Address - Street 2:11F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60546
Practice Address - Country:US
Practice Address - Phone:312-569-7354
Practice Address - Fax:312-569-7522
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE83645Medicare UPIN