Provider Demographics
NPI:1366459406
Name:STEVEN GOLLISH MD PC
Entity Type:Organization
Organization Name:STEVEN GOLLISH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-773-7711
Mailing Address - Street 1:1201 SOUTH DR
Mailing Address - Street 2:SUITE 352
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3256
Mailing Address - Country:US
Mailing Address - Phone:989-773-7711
Mailing Address - Fax:989-772-0041
Practice Address - Street 1:1201 SOUTH DR
Practice Address - Street 2:SUITE 352
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3256
Practice Address - Country:US
Practice Address - Phone:989-773-7711
Practice Address - Fax:989-772-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISG045866208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1524935Medicaid
MI1524935Medicaid
P28330002Medicare PIN