Provider Demographics
NPI:1457321598
Name:GILLIGAN, DANIEL PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PATRICK
Last Name:GILLIGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9397 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:KALEVA
Mailing Address - State:MI
Mailing Address - Zip Code:49645-9783
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1615 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:MI
Practice Address - Zip Code:49304-7984
Practice Address - Country:US
Practice Address - Phone:231-745-4624
Practice Address - Fax:231-745-5031
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH19561Medicare UPIN