Provider Demographics
NPI:1790128015
Name:DAVID N GASBARRO
Entity Type:Organization
Organization Name:DAVID N GASBARRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:GASBARRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-862-3030
Mailing Address - Street 1:518 BURNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-3401
Mailing Address - Country:US
Mailing Address - Phone:708-862-3030
Mailing Address - Fax:708-862-3030
Practice Address - Street 1:518 BURNHAM AVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-3401
Practice Address - Country:US
Practice Address - Phone:708-862-3030
Practice Address - Fax:708-862-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002449213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6080100001Medicare NSC