Provider Demographics
NPI:1861752123
Name:GORSKI, JULIE ANN (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:GORSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:25 N WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-377-7900
Mailing Address - Fax:630-377-8007
Practice Address - Street 1:2900 FOXFIELD RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-377-7900
Practice Address - Fax:630-377-8007
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56550207Q00000X
IL036138813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001-0104862OtherMEDICA
MN1861752123Medicaid
P01224930OtherRR MEDICARE
MN1861752123OtherBCBS
IL920540OtherMEDICARE GROUP
ILF400409280OtherMEDICARE INDIVIDUAL
IL920540OtherMEDICARE GROUP