Individual
GERALD J MINGOLELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17850 KEDZIE AVE, 3200, HAZEL CREST, IL 60429-2058
(708) 798-8112
(708) 798-9016
Mailing address
PO BOX 967, TINLEY PARK, IL 60477-0967
(708) 532-6029
(708) 532-6095
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036085438
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036085438
—
IL
Enumeration date
07/05/2005
Last updated
01/03/2013
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