Provider Demographics
NPI:1538360623
Name:PATRICK, GAIL LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:LYNN
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2424 W. PETERSON
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659
Mailing Address - Country:US
Mailing Address - Phone:773-761-0300
Mailing Address - Fax:773-761-0009
Practice Address - Street 1:2501 W. PETERSON
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60059
Practice Address - Country:US
Practice Address - Phone:773-761-0300
Practice Address - Fax:773-878-1073
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336-078118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine