Provider Demographics
NPI:1831528553
Name:GILLS, FELICIA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:GILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-3343
Mailing Address - Country:US
Mailing Address - Phone:630-293-7387
Mailing Address - Fax:630-293-9161
Practice Address - Street 1:675 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3343
Practice Address - Country:US
Practice Address - Phone:630-293-7387
Practice Address - Fax:630-293-9161
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver