Provider Demographics
NPI:1629012117
Name:GILL, KALEEM U (MD)
Entity Type:Individual
Prefix:
First Name:KALEEM
Middle Name:U
Last Name:GILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2751 BAY PARK DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-4921
Mailing Address - Country:US
Mailing Address - Phone:419-690-7682
Mailing Address - Fax:419-693-2931
Practice Address - Street 1:2751 BAY PARK DR
Practice Address - Street 2:SUITE 303
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4921
Practice Address - Country:US
Practice Address - Phone:419-690-7682
Practice Address - Fax:419-693-2931
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.086938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06278OtherPARAMOUNT
OH3072547250OtherHNFS
OH7441825OtherAETNA
OHP00335077OtherRRMC
OH3072547250-00OtherBWC
OH2657049Medicaid
OH2657049Medicaid
OHGI4184181Medicare PIN
OH4184184Medicare PIN
OHP00335077OtherRRMC