Provider Demographics
NPI:1831310648
Name:GILL, POONAM J (MD)
Entity Type:Individual
Prefix:MRS
First Name:POONAM
Middle Name:J
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:POONAM
Other - Middle Name:J
Other - Last Name:BRAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2500 W HIGGINS RD STE 1120
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-2050
Mailing Address - Country:US
Mailing Address - Phone:847-906-3022
Mailing Address - Fax:855-754-0596
Practice Address - Street 1:2500 W HIGGINS RD STE 1120
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2050
Practice Address - Country:US
Practice Address - Phone:847-906-3022
Practice Address - Fax:855-754-0596
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36117480207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117480Medicaid