Provider Demographics
NPI:1295794683
Name:GILSDORF, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:GILSDORF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 ARNET ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5753
Mailing Address - Country:US
Mailing Address - Phone:734-483-0404
Mailing Address - Fax:734-481-0844
Practice Address - Street 1:200 ARNET ST
Practice Address - Street 2:SUITE 110
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5753
Practice Address - Country:US
Practice Address - Phone:734-483-0404
Practice Address - Fax:734-481-0844
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301045438208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101875OtherCARE CHOICE / PREF CHOICE
MI1970536Medicaid
MIB48642OtherUPIN
MI0004109376OtherAETNA
MI0208110311OtherBCBSM
MI11276974OtherCAQH PROVIDER NUMBER
MIDC6914OtherRAILROAD MEDICARE
MIB48642OtherHAP
MI1970536Medicaid