Basic Information
| Provider Information | |||||||||
| NPI: | 1053584862 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GABA | ||||||||
| FirstName: | RON | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1754 W WELLINGTON AVE | ||||||||
| Address2: | APARTMENT 3E | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606574045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732632312 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1740 W TAYLOR ST | ||||||||
| Address2: | MC 931 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606127232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129960235 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2008 | ||||||||
| LastUpdateDate: | 01/23/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 036115298 | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.