Individual
MATTHEW GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1740 W TAYLOR ST, CHICAGO, IL 60612-7232
(866) 600-2273
Mailing address
11041 WYSTONE AVE, PORTER RANCH, CA 91326-2348
(818) 631-2475
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
125070484
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2017
Last updated
05/21/2020
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