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Contact Information

SAM GAINES, MD
VIRGINIA & FRANKLIN STREETS
NORMAL, IL61761
 Phone: 309-827-4321
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Emergency Medical Services

207PE0004X 93 Physician/Emergency Medicine
 

Emergency Medicine

207P00000X 93 Physician/Emergency Medicine
Indicates primary specialty

NPI Profile & details for SAM GAINES · (Male)

NPI # 1730115643
Status Active
Credentials MD
Entity Individual
Enumeration date 06/23/2006
Last updated 12/28/2021 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 036-057022
  • IL License # 036057022
  • IL Medicaid 036057022
  • IL Medicaid 036057022-1
  • IL Other 05721369 BC/BS
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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