Provider Demographics
NPI:1255715579
Name:GILLIHAN, PATRICK (DPM)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:GILLIHAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 E QUEEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-2019
Mailing Address - Country:US
Mailing Address - Phone:480-216-4395
Mailing Address - Fax:480-917-5400
Practice Address - Street 1:1831 E QUEEN CREEK RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-2019
Practice Address - Country:US
Practice Address - Phone:480-216-4395
Practice Address - Fax:480-917-5400
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ000904213ES0103X
AZPOD-000904213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ413038Medicaid