Individual
MR. JAMES KEVIN GILLIGAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD, LD
Contact information
Practice address
501 LAKE LAND BLVD, MATTOON, IL 61938-5283
(217) 258-3370
Mailing address
6612 WINNEBAGO ST, SAINT LOUIS, MO 63109-1245
(314) 537-0932
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164006502
IL
133V00000X
Registered Dietitian
2012036779
MO
Other
Enumeration date
07/27/2015
Last updated
07/27/2015
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