Provider Demographics
NPI:1073245874
Name:GILLES MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GILLES MEDICAL CORPORATION
Other - Org Name:GILLES FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:GILLES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:760-477-3776
Mailing Address - Street 1:525 LIVERPOOL DR
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1813
Mailing Address - Country:US
Mailing Address - Phone:760-477-3776
Mailing Address - Fax:
Practice Address - Street 1:320 SANTA FE DR STE 305
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5140
Practice Address - Country:US
Practice Address - Phone:760-477-3776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty