Provider Demographics
NPI:1295923993
Name:GERICARE, LTD
Entity type:Organization
Organization Name:GERICARE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIONISIO-BUNIAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-299-7888
Mailing Address - Street 1:1600 W DEMPSTER ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1109
Mailing Address - Country:US
Mailing Address - Phone:847-299-7888
Mailing Address - Fax:847-299-7844
Practice Address - Street 1:1600 W DEMPSTER ST
Practice Address - Street 2:SUITE 120
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1109
Practice Address - Country:US
Practice Address - Phone:847-299-7888
Practice Address - Fax:847-299-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203786Medicare PIN
ILU81137Medicare UPIN