Provider Demographics
NPI:1720135502
Name:DAVIS, GILLA PRIZANT (MD)
Entity Type:Individual
Prefix:DR
First Name:GILLA
Middle Name:PRIZANT
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:310 HAPP RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3455
Mailing Address - Country:US
Mailing Address - Phone:847-441-9933
Mailing Address - Fax:847-441-9723
Practice Address - Street 1:310 HAPP RD
Practice Address - Street 2:SUITE 204
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3455
Practice Address - Country:US
Practice Address - Phone:847-441-9933
Practice Address - Fax:847-441-9723
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD140983Medicare UPIN