Provider Demographics
NPI:1962449140
Name:KING, GARTRELL D (MD)
Entity Type:Individual
Prefix:DR
First Name:GARTRELL
Middle Name:D
Last Name:KING
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2 E 22ND ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4976
Mailing Address - Country:US
Mailing Address - Phone:630-376-6317
Mailing Address - Fax:630-376-6319
Practice Address - Street 1:2 E 22ND ST
Practice Address - Street 2:SUITE 306
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4976
Practice Address - Country:US
Practice Address - Phone:630-376-6317
Practice Address - Fax:630-376-6319
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-10-20
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Provider Licenses
StateLicense IDTaxonomies
IL036056245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine