Provider Demographics
NPI:1962453746
Name:GILLIS, RICK D (MD)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:D
Last Name:GILLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:840 N 87TH ST
Mailing Address - Street 2:SARGEANT HEALTH CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3586
Mailing Address - Country:US
Mailing Address - Phone:414-805-5540
Mailing Address - Fax:414-805-7878
Practice Address - Street 1:840 N 87TH ST
Practice Address - Street 2:SARGEANT HEALTH CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3586
Practice Address - Country:US
Practice Address - Phone:414-805-5540
Practice Address - Fax:414-805-7878
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI30397207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1962453746Medicaid
002000117GOtherHUMANA
110088240OtherRAILROAD MEDICARE
WI1962453746Medicaid
002000117GOtherHUMANA