Provider Demographics
NPI:1407904717
Name:GILMOUR, GREGORY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOHN
Last Name:GILMOUR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:JOHN
Other - Last Name:GILMOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-364-5260
Mailing Address - Fax:517-364-5251
Practice Address - Street 1:1200 E MICHIGAN AVE STE 520
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1899
Practice Address - Country:US
Practice Address - Phone:517-364-5356
Practice Address - Fax:517-364-5251
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301109712208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00289218OtherRR MEDICARE
IAV08802Medicare UPIN
IA0486878Medicaid
IA13229OtherWELLMARK BC BS
IA250355OtherMIDLANDS CHOICE
IAI17313Medicare ID - Type Unspecified