Individual
CAROL GERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1031 ASHLAND AVE, RIVER FOREST, IL 60305-1435
(708) 334-5160
Mailing address
1031 ASHLAND AVE, RIVER FOREST, IL 60305-1435
(708) 334-5160
Taxonomy
Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
Primary
036-057108
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036057108
—
IL
01
—
1627123
BCBS PROVIDER ID
IL
Enumeration date
09/19/2005
Last updated
04/25/2012
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