Provider Demographics
NPI:1831263342
Name:GILREATH, RODNEY P (MD)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:P
Last Name:GILREATH
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:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:22505 ALLEN
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183
Mailing Address - Country:US
Mailing Address - Phone:734-671-6217
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:22505 ALLEN
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-4818
Practice Address - Country:US
Practice Address - Phone:734-671-6217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RG407496OtherCOMMERCIAL-COMMERCIAL NUMBER
MI258774210Medicaid
RG407496OtherCHAMPUS-CHAMPUS
080H262390OtherBLUE CROSS-BLUE CROSS