Provider Demographics
NPI:1003337817
Name:GAY, GABRIELLE DENISE (MD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:DENISE
Last Name:GAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5425 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-2342
Mailing Address - Country:US
Mailing Address - Phone:773-378-3347
Mailing Address - Fax:773-378-4028
Practice Address - Street 1:5425 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-2342
Practice Address - Country:US
Practice Address - Phone:773-378-3347
Practice Address - Fax:773-378-4028
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125071506207Q00000X
GA91138207Q00000X
IL036152733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine