Provider Demographics
NPI:1376737353
Name:MICHAEL GILLMAN, M.D., INC.
Entity Type:Organization
Organization Name:MICHAEL GILLMAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-499-8226
Mailing Address - Street 1:31862 COAST HWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6769
Mailing Address - Country:US
Mailing Address - Phone:949-499-8226
Mailing Address - Fax:949-499-2430
Practice Address - Street 1:31862 COAST HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6769
Practice Address - Country:US
Practice Address - Phone:949-499-8226
Practice Address - Fax:949-499-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113000212251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4281300001Medicare NSC
CAW21171Medicare PIN