Individual
MR. MICHAEL JUAN GILMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5471 DR. MARTIN LUTHER KING DR., SAINT LOUIS, MO 63112-4265
(314) 367-5820
(314) 367-6326
Mailing address
5471 DR. MARTIN LUTHER KING DR., STE A, SAINT LOUIS, MO 63112-4265
(314) 367-5820
(314) 367-6326
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A66073
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A66073
—
CA
Enumeration date
04/06/2006
Last updated
10/05/2011
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