Organization
MICHAEL P. GILLILAND, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL P GILLILAND M.D. (PRESIDENT/OWNER)
(979) 297-2755
Entity
Organization
Contact information
Practice address
215 OAK DR S STE D, LAKE JACKSON, TX 77566-5617
(979) 297-2755
(979) 297-9737
Mailing address
215 OAK DR S STE D, LAKE JACKSON, TX 77566-5617
(979) 297-2755
(979) 297-9737
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
F3997
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00AG37
MEDICARE ID
TX
05
—
097351301
—
TX
Enumeration date
08/23/2011
Last updated
08/23/2011
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