Provider Demographics
NPI:1861699795
Name:GALLO, ELISA S (MD)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:S
Last Name:GALLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2640
Mailing Address - Country:US
Mailing Address - Phone:847-382-5111
Mailing Address - Fax:847-382-8993
Practice Address - Street 1:738 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2640
Practice Address - Country:US
Practice Address - Phone:847-382-5111
Practice Address - Fax:847-382-8993
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101264331207N00000X
IL036118764207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology