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Individual
GEORGE R GONNELLA
Active
Individual
GEORGE R GONNELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036100718
IL
208M00000X
Hospitalist Physician
Primary
036100718
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036100718
—
IL
01
—
920540
MEDICARE PTAN (GROUP)
IL
01
—
920540039
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
DB1658
MEDICARE RAILROAD PTAN (GROUP)
IL
01
—
IL8618
MEDICARE PTAN (GROUP)
IL
01
—
IL8618001
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
P01248063
MEDICARE RAILROAD PTAN (INDIVIDUAL)
IL
Enumeration date
01/03/2006
Last updated
01/18/2018
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