| Gcp Illinois, PLLC | |
|
27 Auerbach Pl Glen Carbon IL 62034-1596 | |
| (314) 925-0903 | |
| (314) 764-2279 |
| Full Name | Gcp Illinois, PLLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 27 Auerbach Pl, Glen Carbon, Illinois |
| Authorized Official Name and Position | Mae Lin (OFFICE MANAGER) |
| Authorized Official Contact | 3149250903 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gcp Illinois, PLLC Po Box 14713 Belfast ME 04915-4042 Ph: (314) 925-0903 | Gcp Illinois, PLLC 27 Auerbach Pl Glen Carbon IL 62034-1596 Ph: (314) 925-0903 |
| NPI Number | 1366050007 |
|---|---|
| Provider Enumeration Date | 07/20/2020 |
| Last Update Date | 03/16/2026 |
| Certification Date | 03/16/2026 |
| Medicare PECOS PAC ID | 1557687803 |
|---|---|
| Medicare Enrollment ID | O20200908001358 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366050007 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Secondary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | (NU) | Primary |
| Provider Name | Michelle Burk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093817355 PECOS PAC ID: 5597731273 Enrollment ID: I20040903000319 |
| Provider Name | Amy L Rohlfing |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1255335188 PECOS PAC ID: 3779511258 Enrollment ID: I20050727000618 |
| Provider Name | Katherine a Burnley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013397967 PECOS PAC ID: 0749598829 Enrollment ID: I20151009001910 |
| Provider Name | Marsha R Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154595072 PECOS PAC ID: 6305915943 Enrollment ID: I20160309000877 |
| Provider Name | Nicole Renee Nissen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629569843 PECOS PAC ID: 0547519423 Enrollment ID: I20180910002278 |
| Provider Name | Walter Lin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952481913 PECOS PAC ID: 9931425295 Enrollment ID: I20201205000160 |
| Provider Name | Mary E Maloney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710592175 PECOS PAC ID: 6608285234 Enrollment ID: I20210511001054 |
| Provider Name | Emil Fernando |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982968129 PECOS PAC ID: 2567787237 Enrollment ID: I20251022001136 |
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