Individual
MR. TRAVIS ANDRE GAYLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
333 MADISON STREET, JOLIET, IL 60435-0000
(815) 725-7133
(630) 914-2469
Mailing address
1000 REMINGTON BLVD, SUITE 100, BOLINGBROOK, IL 60440-0000
(630) 914-2417
(630) 914-2499
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036131329
IL
208M00000X
Hospitalist Physician
Primary
036.131329
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036131329
—
IL
Enumeration date
06/10/2009
Last updated
04/22/2014
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