Provider Demographics
NPI:1902138753
Name:GHIONZOLI, ORLAND GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ORLAND
Middle Name:GERARD
Last Name:GHIONZOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21W724 DORCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6463
Mailing Address - Country:US
Mailing Address - Phone:630-858-2186
Mailing Address - Fax:
Practice Address - Street 1:21W724 DORCHESTER CT
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6463
Practice Address - Country:US
Practice Address - Phone:630-858-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.044534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine