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Individual

GAIL E PRENDERGAST

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
403 E. 1ST STREET, KATHERINE SHAW BETHEA HOSPITAL, DIXON, IL 61021
(815) 285-5629
(815) 285-5634
Mailing address
403 E. 1ST STREET, KATHERINE SHAW BETHEA HOSPITAL, DIXON, IL 61021
(815) 285-5629
(815) 285-5634

Taxonomy

Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
036-102246
IL
208M00000X
Hospitalist Physician
036102246
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0222075
BLUE CROSS GROUP NUMER
IL
05
036102246
IL
01
F400261482
MEDICARE PTAN
IL
Enumeration date
07/10/2006
Last updated
09/05/2018
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