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Individual

DR. PATRICK GERARD GANNON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
626 BETHANY RD, 3251 COMMERCE DRIVE, DEKALB, IL 60115-4939
(815) 756-1521
Mailing address
2807 BRITTANY CT, ST CHARLES, IL 60175-5161

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
IL
208D00000X
General Practice Physician
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
021940024;0031940152
BCBS PRVIDER #
IL
01
237087041;651249587
TAX ID NUMBER
IL
Enumeration date
09/21/2006
Last updated
09/11/2025
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