Provider Demographics
NPI:1821052440
Name:GILSON, JAMES WILLARD (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLARD
Last Name:GILSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 N HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3605
Mailing Address - Country:US
Mailing Address - Phone:800-444-6110
Mailing Address - Fax:866-642-1525
Practice Address - Street 1:6200 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187
Practice Address - Country:US
Practice Address - Phone:734-526-8860
Practice Address - Fax:734-353-4108
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003240363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P35076OtherHEALTH ALLIANCE PLAN
MIC7806OtherMCARE
P00097690OtherRAILROAD MEDICARE
P35076OtherHEALTH ALLIANCE PLAN
MIC7806OtherMCARE