Individual
JONATHAN READ GAILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 E MEDICAL CENTER DR, ANN ARBOR, MI 48109-5000
(734) 936-4000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4351045072
MI
2084E0001X
Epilepsy Physician
Primary
4301511387
MI
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
4301511387
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4351045072
LIMITED EDUCATION LICENSE
MI
01
—
5315207176
CONTROLLED SUBSTANCE LICENSE
MI
Enumeration date
05/21/2019
Last updated
09/23/2025
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