Provider Demographics
NPI:1902868607
Name:GELLES, ROBERT (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GELLES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7460 W COLLEGE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1193
Mailing Address - Country:US
Mailing Address - Phone:708-671-9030
Mailing Address - Fax:708-671-9033
Practice Address - Street 1:7460 W COLLEGE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1193
Practice Address - Country:US
Practice Address - Phone:708-671-9030
Practice Address - Fax:708-671-9033
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IL016003361213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003361Medicaid
IL363307387OtherTAX ID
ILT37841Medicare UPIN
1367670001Medicare NSC
IL016003361Medicaid