Provider Demographics
NPI:1184612590
Name:AILLS, JAMES THOMAS (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:AILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4448 OAKBRIDGE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5494
Mailing Address - Country:US
Mailing Address - Phone:810-230-7905
Mailing Address - Fax:810-230-7908
Practice Address - Street 1:4448 OAKBRIDGE DR
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5494
Practice Address - Country:US
Practice Address - Phone:810-230-7905
Practice Address - Fax:810-230-7908
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJA0339882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2602526822OtherBLUE CROSS NUMBER
MI1498263Medicaid
MI2626822OtherHEALTHPLUS NUMBER
MI0P10330Medicare ID - Type UnspecifiedMEDICARE NUMBER
MI2626822OtherHEALTHPLUS NUMBER