Basic Information
| Provider Information | |||||||||
| NPI: | 1114901675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLADEK | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | GEORGE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 CLARIDGE CT | ||||||||
| Address2: | |||||||||
| City: | LAKE VILLA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600465076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473563471 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3001A 6TH ST | ||||||||
| Address2: | NAVAL HOSPITAL GREAT LAKES | ||||||||
| City: | GREAT LAKES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600885230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476884560 | ||||||||
| FaxNumber: | 8476882678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 08/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036056585 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.