Individual
DR. MANDY L GITTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5215 N CALIFORNIA AVE, 7TH FLOOR, CHICAGO, IL 60625-7014
(312) 666-3494
(773) 293-6846
Mailing address
1701 W SUPERIOR ST, CHICAGO, IL 60622-5646
(312) 666-3494
(312) 666-6228
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD00039065
WA
207Q00000X
Family Medicine Physician
01074721A
IN
207Q00000X
Family Medicine Physician
Primary
036-107772
IL
207Q00000X
Family Medicine Physician
036107772
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036107772
—
IL
01
—
11146653
CAQH
IL
Enumeration date
07/06/2006
Last updated
08/10/2021
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