Provider Demographics
NPI:1831996305
Name:ADDISON, GIFTY
Entity type:Individual
Prefix:
First Name:GIFTY
Middle Name:
Last Name:ADDISON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 GREEN BAY RD APT 206B
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3630
Mailing Address - Country:US
Mailing Address - Phone:614-674-1121
Mailing Address - Fax:
Practice Address - Street 1:3505 GREEN BAY RD APT 206B
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3630
Practice Address - Country:US
Practice Address - Phone:614-674-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty