Provider Demographics
NPI:1750355087
Name:GAYE, ANNICK (MD)
Entity type:Individual
Prefix:
First Name:ANNICK
Middle Name:
Last Name:GAYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:MAGUIRE CENTER, RM. 3307
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-4403
Mailing Address - Fax:708-216-3375
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:MAGUIRE CENTER, RM. 3307
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-4403
Practice Address - Fax:708-216-3375
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360621482080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL369062148Medicaid
C39101Medicare UPIN
IL369062148Medicaid