Provider Demographics
NPI:1790045490
Name:TISCHKE, GAIL (DDS)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:TISCHKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2883
Mailing Address - Country:US
Mailing Address - Phone:312-274-3333
Mailing Address - Fax:312-274-3334
Practice Address - Street 1:676 N MICHIGAN AVE
Practice Address - Street 2:SUITE 3500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2883
Practice Address - Country:US
Practice Address - Phone:312-274-3333
Practice Address - Fax:312-274-3334
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist