Provider Demographics
NPI:1184682510
Name:GILL, JONA KAY (MD)
Entity Type:Individual
Prefix:
First Name:JONA
Middle Name:KAY
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14650 OLD US HWY 12
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1805
Mailing Address - Country:US
Mailing Address - Phone:734-475-3221
Mailing Address - Fax:734-475-6411
Practice Address - Street 1:14650 OLD US HWY 12
Practice Address - Street 2:SUITE 308
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1805
Practice Address - Country:US
Practice Address - Phone:734-475-3221
Practice Address - Fax:734-475-6411
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077541207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P09850Medicare PIN
MIP09850001Medicare ID - Type Unspecified
MIH06995Medicare UPIN