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Organization

PRAIRIEVIEW GYN LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DEGAULLE G HAILE (MANAGING MEMBER)
(815) 935-1315
Entity
Organization

Contact information

Practice address
3929 MORGAN TRL, BOURBONNAIS, IL 60914-4738
(815) 935-1315
Mailing address
3929 MORGAN TRL, BOURBONNAIS, IL 60914-4738

Taxonomy

Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
036110330
IL

Other

Enumeration date
07/29/2011
Last updated
07/29/2011
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