Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 4301045761 | MI |
NPI | 1053302562 |
---|---|
Provider Name | Dr. Ward Robert Gillett |
First Address | Traverse City, MI 49684-9687 |
Second Address | Traverse City, MI 49684-9687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 18/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3480016 | (05) | MI |
E26877 | (02) | MI |