Provider Demographics
NPI:1447202064
Name:BRYANT, GAIL G (MD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:G
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:125 S WILKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1534
Mailing Address - Country:US
Mailing Address - Phone:847-637-1600
Mailing Address - Fax:847-637-1606
Practice Address - Street 1:125 S WILKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1534
Practice Address - Country:US
Practice Address - Phone:847-637-1600
Practice Address - Fax:847-637-1606
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036098963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19941Medicare ID - Type Unspecified
ILIL5273Medicare PIN
ILH16087Medicare UPIN
ILIL5273001Medicare PIN