Provider Demographics
NPI: | 1881638930 |
---|---|
Name: | GILMER, HOLLY S (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | HOLLY |
Middle Name: | S |
Last Name: | GILMER |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | HOLLY |
Other - Middle Name: | S |
Other - Last Name: | GILMER HILL |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 29275 NORTHWESTERN HWY |
Mailing Address - Street 2: | STE 100 |
Mailing Address - City: | SOUTHFIELD |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48034 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 248-784-3667 |
Mailing Address - Fax: | 248-869-3982 |
Practice Address - Street 1: | 29275 NORTHWESTERN HWY |
Practice Address - Street 2: | STE 100 |
Practice Address - City: | SOUTHFIELD |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48034 |
Practice Address - Country: | US |
Practice Address - Phone: | 248-784-3667 |
Practice Address - Fax: | 248-869-3982 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-16 |
Last Update Date: | 2024-04-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 4301073732 | 207T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MI | 0828632 | Other | BCBS OF MICHIGAN |
MI | 104210122 | Medicaid | |
MI | 0828632 | Other | BCBS OF MICHIGAN |
MI | OM95680 004 | Medicare ID - Type Unspecified |