Provider Demographics
NPI:1497841548
Name:GILLETTE INTERNAL MEDICINE ASSOCIATES PC
Entity Type:Organization
Organization Name:GILLETTE INTERNAL MEDICINE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRTIKUMAR
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-682-0400
Mailing Address - Street 1:407 S MEDICAL ARTS CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3372
Mailing Address - Country:US
Mailing Address - Phone:307-682-0400
Mailing Address - Fax:307-686-7420
Practice Address - Street 1:407 S MEDICAL ARTS CT
Practice Address - Street 2:SUITE D
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3372
Practice Address - Country:US
Practice Address - Phone:307-682-0400
Practice Address - Fax:307-686-7420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY113341100Medicaid
WY113341100Medicaid