Individual
DR. OLIVER D GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17501 GENERATIONS DR, SOUTH BEND, IN 46635-1589
(574) 234-0049
(574) 251-2861
Mailing address
17501 GENERATIONS DR, SOUTH BEND, IN 46635-1589
(574) 234-0049
(574) 251-2861
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01035882A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084427
ANTHEM
IN
01
—
100010837
RAILROAD MEDICARE
IN
05
—
100090510
—
IN
01
—
2738533002
CIGNA
IN
01
—
4667992
AETNA
IN
Enumeration date
06/02/2005
Last updated
01/21/2011
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