Provider Demographics
NPI:1669454013
Name:GILLIATTE, MICHELLE M (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:M
Last Name:GILLIATTE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20905 E 12 MILE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-6501
Mailing Address - Country:US
Mailing Address - Phone:586-772-3500
Mailing Address - Fax:586-772-6540
Practice Address - Street 1:20905 E 12 MILE RD
Practice Address - Street 2:STE 100
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-6501
Practice Address - Country:US
Practice Address - Phone:586-772-3500
Practice Address - Fax:586-772-6540
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002041213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4612236Medicaid
MI4855011050OtherBCBS
MI1669454013OtherMEDICARE RAILROAD
MI1669454013OtherMEDICARE RAILROAD
MI4612236Medicaid