Provider Demographics
NPI:1538653787
Name:VIJAY S GILL MD PC
Entity Type:Organization
Organization Name:VIJAY S GILL MD PC
Other - Org Name:VIJAY S GILL MD FACP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACP
Authorized Official - Phone:480-964-1702
Mailing Address - Street 1:2152 S VINEYARD STE 119
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6881
Mailing Address - Country:US
Mailing Address - Phone:480-964-1702
Mailing Address - Fax:480-964-1737
Practice Address - Street 1:2152 S VINEYARD STE 119
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6881
Practice Address - Country:US
Practice Address - Phone:480-964-1702
Practice Address - Fax:480-964-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22590261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ354316Medicaid