Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 180754 | NY |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 4301098753 | MI |
NPI | 1609849868 |
---|---|
Provider Name | Dr. Philip Alain Gilly |
First Address | West Bloomfield, MI 48322-3013 |
Second Address | West Bloomfield, MI 48322-3013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 17/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01166201 | (05) | NY |
F44628 | (02) |