Individual
GEORGE R GONNELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
300 RANDALL RD, GENEVA, IL 60134-4200
(630) 933-4700
(630) 933-4427
Mailing address
300 RANDALL RD, GENEVA, IL 60134-4200
(630) 933-4700
(630) 933-4427
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036100718
IL
208M00000X
Hospitalist Physician
Primary
036100718
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036100718
—
IL
01
—
920540
MEDICARE PTAN (GROUP)
IL
01
—
920540039
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
DB1658
MEDICARE RAILROAD PTAN (GROUP)
IL
01
—
IL8618
MEDICARE PTAN (GROUP)
IL
01
—
IL8618001
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
P01248063
MEDICARE RAILROAD PTAN (INDIVIDUAL)
IL
Enumeration date
01/03/2006
Last updated
01/18/2018
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