Individual
JEFFREY GILLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4727 SAINT ANTOINE ST, SUITE 210, DETROIT, MI 48201-1461
(313) 831-3066
(313) 831-8438
Mailing address
43800 GARFIELD RD, CLINTON TWP, MI 48038-1136
(800) 848-0202
(586) 226-6949
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301041555
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4502243
—
MI
05
—
5188750
—
MI
05
—
5215491
—
MI
Enumeration date
10/11/2005
Last updated
02/01/2010
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