Basic Information
Provider Information | |||||||||
NPI: | 1548466725 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GILLEY | ||||||||
FirstName: | EMILY | ||||||||
MiddleName: | ANNE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1000 N WESTMORELAND RD # LEVEL3 | ||||||||
Address2: |   | ||||||||
City: | LAKE FOREST | ||||||||
State: | IL | ||||||||
PostalCode: | 600451658 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8475358500 | ||||||||
FaxNumber: | 8475358488 | ||||||||
Practice Location | |||||||||
Address1: | 1000 N WESTMORELAND RD # LEVEL3 | ||||||||
Address2: |   | ||||||||
City: | LAKE FOREST | ||||||||
State: | IL | ||||||||
PostalCode: | 60045 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8475358500 | ||||||||
FaxNumber: | 8475358488 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2007 | ||||||||
LastUpdateDate: | 08/23/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | 036147047 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No ID Information.