Provider Demographics
NPI:1568468981
Name:GILLER, HARVEY ALAN (DO)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:ALAN
Last Name:GILLER
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:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-222-7600
Mailing Address - Fax:515-222-7643
Practice Address - Street 1:1601 NW 114TH ST
Practice Address - Street 2:STE 342
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7036
Practice Address - Country:US
Practice Address - Phone:515-222-7600
Practice Address - Fax:515-222-7643
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01719207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0159038Medicaid
IA0159038Medicaid
IA24385Medicare ID - Type Unspecified