Provider Demographics
NPI:1962442509
Name:GILL, SANTOSH K (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTOSH
Middle Name:K
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2088 OGDEN AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4383
Mailing Address - Country:US
Mailing Address - Phone:630-851-6440
Mailing Address - Fax:630-851-7001
Practice Address - Street 1:2088 OGDEN AVE STE 160
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4383
Practice Address - Country:US
Practice Address - Phone:630-851-6440
Practice Address - Fax:630-851-7001
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062343207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL060052717OtherRAILROAD MEDICARE
IL036062343Medicaid
IL060052717OtherRAILROAD MEDICARE
IL036062343Medicaid
IL060052717Medicare PIN
IL060052717OtherRAILROAD MEDICARE
ILL52198Medicare ID - Type Unspecified