Provider Demographics
NPI:1851523377
Name:GORSUCH, JILL L (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:L
Last Name:GORSUCH
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:L
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO, MPH
Mailing Address - Street 1:42 N SAINT JOSEPH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2203
Mailing Address - Country:US
Mailing Address - Phone:269-684-6696
Mailing Address - Fax:269-684-5286
Practice Address - Street 1:42 N SAINT JOSEPH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2203
Practice Address - Country:US
Practice Address - Phone:269-684-6696
Practice Address - Fax:269-684-5286
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1593656208600000X
MI5101018409208600000X
AZ006332208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery