Provider Demographics
NPI:1881682227
Name:GILLUM, HEATHER N (MD PSYCHIATRIST)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:N
Last Name:GILLUM
Suffix:
Gender:F
Credentials:MD PSYCHIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6237
Mailing Address - Country:US
Mailing Address - Phone:407-875-3700
Mailing Address - Fax:
Practice Address - Street 1:434 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810
Practice Address - Country:US
Practice Address - Phone:407-875-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1326772084P0800X
MA2369002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H91336Medicare UPIN