Organization
JAMES R GILSDORF MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA HACALA (CREDENTIALING)
(248) 457-9210
Entity
Organization
Contact information
Practice address
200 ARNET ST, SUITE 110, YPSILANTI, MI 48198-5753
(734) 483-0404
(734) 481-0844
Mailing address
200 ARNET ST, SUITE 110, YPSILANTI, MI 48198-5753
(734) 483-0404
(734) 481-0844
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301045438
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004109376
AETNA
MI
01
—
11276974
CAQH
MI
05
—
1970536
—
MI
01
—
B48642
HAP
MI
01
—
DC6914
RAILROAD MEDICARE
MI
01
—
P101875
CARE CHOICES
MI
Enumeration date
11/27/2007
Last updated
11/27/2007
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