Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 11044 | MI |
NPI | 1033281852 |
---|---|
Provider Name | Dr. James Gillig |
First Address | Canton, MI 48487-4630 |
Second Address | Wayne, MI 48184 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |