Provider Demographics
NPI:1780782383
Name:GERSTEIN, MELVYN A (MD)
Entity type:Individual
Prefix:DR
First Name:MELVYN
Middle Name:A
Last Name:GERSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3042 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3729
Mailing Address - Country:US
Mailing Address - Phone:773-973-3223
Mailing Address - Fax:773-973-1119
Practice Address - Street 1:3042 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3729
Practice Address - Country:US
Practice Address - Phone:773-973-3223
Practice Address - Fax:773-973-1119
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21603195OtherBCBS PROVIDER NUMBER
IL036041953-1Medicaid
IL036041953-1Medicaid