Provider Demographics
NPI:1376647636
Name:GILLES, ELIZABETH E (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:GILLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:360 SHERMAN ST
Mailing Address - Street 2:SUITE 399
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2564
Mailing Address - Country:US
Mailing Address - Phone:651-356-6080
Mailing Address - Fax:651-356-8486
Practice Address - Street 1:360 SHERMAN ST
Practice Address - Street 2:SUITE 399
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2564
Practice Address - Country:US
Practice Address - Phone:651-356-6080
Practice Address - Fax:651-356-8486
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2016-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN42885208000000X, 2084N0400X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN849640400Medicaid
E71853Medicare UPIN