Provider Demographics
NPI:1821277559
Name:GABRIEL, JOSE MARIA HILARIO
Entity Type:Individual
Prefix:DR
First Name:JOSE MARIA
Middle Name:HILARIO
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GABRIEL
Other - Middle Name:CID
Other - Last Name:CALILAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:306 ERA DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1834
Mailing Address - Country:US
Mailing Address - Phone:847-509-9779
Mailing Address - Fax:
Practice Address - Street 1:7531 S STONY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3954
Practice Address - Country:US
Practice Address - Phone:773-947-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107546207ZC0006X, 207ZP0102X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636129OtherIL BCBS
ILP00724370OtherRAILROAD MEDICARE
IL036107546Medicaid
IL01636129OtherIL BCBS
IL798230002Medicare PIN