Provider Demographics
NPI:1427042647
Name:GILL, LIVELEEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:LIVELEEN
Middle Name:M
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:725 ORCHARD PARK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3352
Mailing Address - Country:US
Mailing Address - Phone:716-674-4006
Mailing Address - Fax:716-674-2259
Practice Address - Street 1:ELM AND CARLTON STREETS
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-0001
Practice Address - Country:US
Practice Address - Phone:716-845-2300
Practice Address - Fax:518-761-7037
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152871174400000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00845643Medicaid
NYB71065Medicare UPIN
NY004711Medicare ID - Type Unspecified