Individual
MARY ROXANNE GILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 898-0727
Mailing address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 898-0727
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
5101027958
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/13/2021
Last updated
01/28/2025
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