Organization
GEORGE GONNELLA DO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE GONNELLA DO (OWNER)
(815) 748-3040
Entity
Organization
Contact information
Practice address
2560 HAUSER ROSS DR, SUITE 450, SYCAMORE, IL 60178-3150
(815) 748-3040
Mailing address
2560 HAUSER ROSS DR, SUITE 450, SYCAMORE, IL 60178-3150
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001932042
BC BS
IL
05
—
036100718
—
IL
Enumeration date
05/10/2006
Last updated
07/16/2008
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