Provider Demographics
NPI:1548361959
Name:EGEKEZE, GILBERT N (MD)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:N
Last Name:EGEKEZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5480 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6211
Mailing Address - Country:US
Mailing Address - Phone:815-477-7800
Mailing Address - Fax:815-477-7812
Practice Address - Street 1:5911 NORTHWEST HWY
Practice Address - Street 2:#205
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-8065
Practice Address - Country:US
Practice Address - Phone:815-477-7800
Practice Address - Fax:815-477-7812
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036100558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100558Medicaid
IL04532115OtherBLUE CROSS/SHIELD
ILP00192277OtherRAIL ROAD MEDICARE
IL04532115OtherBLUE CROSS/SHIELD
IL036100558Medicaid
ILP00192277OtherRAIL ROAD MEDICARE