Provider Demographics
NPI:1548613995
Name:GI PARTNERS OF ILLINOIS, LLC
Entity type:Organization
Organization Name:GI PARTNERS OF ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDONATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-247-0187
Mailing Address - Street 1:1880 W WINCHESTER RD
Mailing Address - Street 2:#201
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5341
Mailing Address - Country:US
Mailing Address - Phone:847-247-0187
Mailing Address - Fax:847-247-0487
Practice Address - Street 1:1880 W WINCHESTER RD
Practice Address - Street 2:#201
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5341
Practice Address - Country:US
Practice Address - Phone:847-247-0187
Practice Address - Fax:847-247-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty