Basic Information
| Provider Information | |||||||||
| NPI: | 1558355438 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILES | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022725063 | ||||||||
| FaxNumber: | 5027721761 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 W BROADWAY STE 107 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402033607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023405900 | ||||||||
| FaxNumber: | 5027721761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 22657 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 22657 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1049423 | 01 | PASSPORT | OTHER | 0400136 | 01 | UNITED HEALTHCARE | OTHER | 000000062872 | 01 | ANTHEM | OTHER | 64226574 | 05 | KY | MEDICAID |