Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901400351 | MI |
Y | 222Z00000X | Podiatrist | 5901400351 | MI |
N | 213ES0103X | Foot & Ankle Surgery | 5901002658 | MI |
NPI | 1063968618 |
---|---|
Provider Name | Dr. Rachel M Gillespie |
First Address | Ferndale, MI 48220-1096 |
Second Address | Madison Heights, MI 48071-4439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 30/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0N79800 | (02) | MI |
23-0264 | (05) | MI |