Individual
DR. MICHAEL WILLIAM GILLILAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1322 3RD ST SE, SUITE 100, PUYALLUP, WA 98372-3771
(253) 697-4128
Mailing address
1498 SE TECH CENTER PL, SUITE 340, VANCOUVER, WA 98683-9591
(360) 260-0235
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
MD00042973
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1119296
—
WA
01
—
1322GI
REGENCE BLUE SHIELD ID
WA
01
—
20202185198372A002
TRICARE ID
WA
01
—
P00257376
RAILROAD MEDICARE ID
WA
Enumeration date
07/27/2006
Last updated
07/09/2007
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