Provider Demographics
NPI:1477970531
Name:GILL, CHAMKAUR (NP)
Entity Type:Individual
Prefix:MR
First Name:CHAMKAUR
Middle Name:
Last Name:GILL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24224 JOY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1215
Mailing Address - Country:US
Mailing Address - Phone:313-565-6663
Mailing Address - Fax:313-565-6632
Practice Address - Street 1:39353 HEATHERBROOK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-2918
Practice Address - Country:US
Practice Address - Phone:313-565-6663
Practice Address - Fax:313-565-6632
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704157367363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1477970531Medicaid
MIP38590004Medicare PIN