Provider Demographics
NPI:1093039372
Name:MICHAEL D. GILL MD INC
Entity Type:Organization
Organization Name:MICHAEL D. GILL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-735-7621
Mailing Address - Street 1:1025 E. OCEAN AVE,
Mailing Address - Street 2:STE A
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7088
Mailing Address - Country:US
Mailing Address - Phone:805-735-7621
Mailing Address - Fax:805-736-5378
Practice Address - Street 1:1025 E. OCEAN AVE
Practice Address - Street 2:STE. A
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7088
Practice Address - Country:US
Practice Address - Phone:805-735-7621
Practice Address - Fax:805-736-5378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54515207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG54515OtherLICENSE#
CAG54515OtherLICENSE#