Provider Demographics
NPI:1568404960
Name:GARY G. GILYARD MD PC
Entity Type:Organization
Organization Name:GARY G. GILYARD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:GILYARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-575-9444
Mailing Address - Street 1:28800 RYAN RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4272
Mailing Address - Country:US
Mailing Address - Phone:586-575-9444
Mailing Address - Fax:586-575-9446
Practice Address - Street 1:28800 RYAN RD
Practice Address - Street 2:SUITE 280
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4272
Practice Address - Country:US
Practice Address - Phone:586-575-9444
Practice Address - Fax:586-575-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P42790Medicare PIN