Provider Demographics
NPI:1285656173
Name:GILOMEN, JEAN M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:M
Last Name:GILOMEN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:8700 W WATERTOWN PLANK RD
Mailing Address - Street 2:DEPARTMENT OF PLASTIC SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3595
Mailing Address - Country:US
Mailing Address - Phone:414-805-5440
Mailing Address - Fax:414-259-0901
Practice Address - Street 1:8700 W WATERTOWN PLANK RD
Practice Address - Street 2:DEPARTMENT OF PLASTIC SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3595
Practice Address - Country:US
Practice Address - Phone:414-805-5440
Practice Address - Fax:414-259-0901
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1285656173Medicaid
WI004U 73-601Medicare PIN