Provider Demographics
NPI:1750398095
Name:PIERRE, GAMILAH N (MD)
Entity type:Individual
Prefix:DR
First Name:GAMILAH
Middle Name:N
Last Name:PIERRE
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 1:1890 SILVER CROSS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9626
Mailing Address - Country:US
Mailing Address - Phone:815-463-3000
Mailing Address - Fax:815-463-3013
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9524
Practice Address - Country:US
Practice Address - Phone:815-463-3000
Practice Address - Fax:815-463-3013
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36107057207V00000X
IL03610705207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107057Medicaid
K29079Medicare PIN
ILH64552Medicare UPIN