Provider Demographics
NPI:1902210164
Name:DE GALE, ALEXIS (DVM)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:DE GALE
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 BONAVENTURE DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3277
Mailing Address - Country:US
Mailing Address - Phone:847-584-0200
Mailing Address - Fax:
Practice Address - Street 1:1050 BONAVENTURE DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3277
Practice Address - Country:US
Practice Address - Phone:847-584-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090011280284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL090011280OtherIL DVM LICENSE NUMBER
IL090011280OtherIL DVM LICENSE NUMBER