Basic Information
| Provider Information | |||||||||
| NPI: | 1518954270 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIZZO-WAITLEY | ||||||||
| FirstName: | GAIL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 N WINFIELD RD | ||||||||
| Address2: | |||||||||
| City: | WINFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601901295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309334700 | ||||||||
| FaxNumber: | 6309334427 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 N. WINFIELD | ||||||||
| Address2: | |||||||||
| City: | WINFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601901295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309334700 | ||||||||
| FaxNumber: | 6309334427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2005 | ||||||||
| LastUpdateDate: | 01/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036092533 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 036092533 | IL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 036092533 2 | 05 | IL | MEDICAID | CA4748 | 01 | IL | MEDICARE RAILROAD (GROUP) | OTHER | 9919630 | 01 | IL | BCBS | OTHER | P01258419 | 01 | IL | MEDICARE RAILROAD (INDIVIDUAL) | OTHER | 206147 | 01 | IL | MEDICARE PTAN (GROUP) | OTHER | 206147242 | 01 | IL | MEDICARE PTAN (INDIVIDUAL) | OTHER |