Provider Demographics
NPI:1982769717
Name:GEROULIS, ANTHONY JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JAMES
Last Name:GEROULIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WEST FRONTAGE RD.
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093
Mailing Address - Country:US
Mailing Address - Phone:847-441-4441
Mailing Address - Fax:847-784-9744
Practice Address - Street 1:330 WEST FRONTAGE RD.
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:847-441-4441
Practice Address - Fax:847-784-9744
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050050207YX0905X
IL36.050050207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050050Medicaid
L28981Medicare ID - Type Unspecified