1033172549 NPI number — DR. CINDY KURRASCH GILMORE PSYD

Table of content: DR. CINDY KURRASCH GILMORE PSYD (NPI 1033172549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033172549 NPI number — DR. CINDY KURRASCH GILMORE PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILMORE
Provider First Name:
CINDY
Provider Middle Name:
KURRASCH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033172549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
431 LENOX STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60302-1339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-660-0747
Provider Business Mailing Address Fax Number:
708-660-0746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1144 LAKE STREET
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-386-0800
Provider Business Practice Location Address Fax Number:
708-660-0746
Provider Enumeration Date:
04/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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