Provider Demographics
NPI:1972813970
Name:GAIL BRYANT MDSC
Entity Type:Organization
Organization Name:GAIL BRYANT MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-637-1600
Mailing Address - Street 1:125 S WILKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1534
Mailing Address - Country:US
Mailing Address - Phone:847-637-1600
Mailing Address - Fax:847-637-1606
Practice Address - Street 1:125 S WILKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1534
Practice Address - Country:US
Practice Address - Phone:847-637-1600
Practice Address - Fax:847-637-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-12
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1601983OtherBCBS
ILIL5273Medicare PIN