Individual
BETH L GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
W3275 WOLF RIVER DR, KESHENA, WI 54135-9202
(715) 799-3361
(715) 799-1326
Mailing address
PO BOX 970, KESHENA, WI 54135-0970
(715) 799-5490
(715) 799-5854
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25269-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30556300
—
WI
Enumeration date
07/07/2006
Last updated
10/22/2018
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