Provider Demographics
NPI:1962641365
Name:HILTON GORDON MD
Entity Type:Organization
Organization Name:HILTON GORDON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HNATIW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-241-1495
Mailing Address - Street 1:484 LEE ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4610
Mailing Address - Country:US
Mailing Address - Phone:630-241-1495
Mailing Address - Fax:630-241-1543
Practice Address - Street 1:484 LEE ST
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4610
Practice Address - Country:US
Practice Address - Phone:630-241-1495
Practice Address - Fax:630-241-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL724670Medicare PIN