Provider Demographics
NPI:1134338809
Name:GILLIO, ANDREA EVE (DPM)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:EVE
Last Name:GILLIO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4312
Mailing Address - Country:US
Mailing Address - Phone:773-282-3777
Mailing Address - Fax:773-282-9410
Practice Address - Street 1:3248 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4312
Practice Address - Country:US
Practice Address - Phone:773-282-3777
Practice Address - Fax:773-282-9410
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16005330213ES0103X
IL016005330213EP1101X
WI1000-25213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1134338809Medicaid
IAP01788700OtherRAILROAD MEDICARE
IL016005330Medicaid
WI1134338809Medicaid
WI1134338809Medicaid
IL016005330Medicaid
ILP01050114Medicare PIN
IA1134338809Medicaid
IL753600006Medicare PIN
IL016005330Medicaid
WI865330024Medicare PIN
WIK400118540Medicare PIN
IL753600006Medicare PIN
IL560750013Medicare PIN