Organization
BRENT W GILLUM D O PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT WINSTON GILLUM D.O. (PHYSICAN)
(313) 831-3066
Entity
Organization
Contact information
Practice address
4727 SAINT ANTOINE ST, SUITE 210, DETROIT, MI 48201-1461
(313) 831-3066
(313) 831-8438
Mailing address
4727 SAINT ANTOINE ST, SUITE 210, DETROIT, MI 48201-1461
(313) 831-3066
(313) 831-8438
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
007845
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4850953
—
MI
Enumeration date
06/06/2006
Last updated
11/07/2007
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