Gaines, Sam

Gaines, Sam is an individual health care provider with primary practice located at Virginia & Franklin Streets , Normal IL 61761. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Emergency Medical Services, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Gaines, Sam can be contacted via phone (309) 827-4321.

Contact Information

Primary practice address
Virginia & Franklin Streets Normal IL 61761
Phone: (309) 827-4321
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 036-057022 Illinois
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X 036-057022 Illinois
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036057022 Illinois

Profile Details

NPI number 1730115643
LBN Legal business name Gaines, Sam
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 23rd, 2006
Last updated Dec 28th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730115643 NPPES
Illinois MEDICAID 036057022-1
Illinois Other 05721369
Illinois MEDICAID 036057022

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