MEDICARE: DR. MICHAEL S. GILLIGAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	ME53014	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	020032009	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	05911	OTHER	BCBS FL
2	204077	OTHER	AVMED
3	0447391	OTHER	CIGNA
5	4045261	OTHER	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558329789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL S. GILLIGAN M.D.

Provider Business Mailing Address
First Line	:	11945 SAN JOSE BLVD.
Second Line	:	BLDG 300
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-396-1725
Fax Number	:	904-399-1717

Provider Business Practice Location Address
First Line	:	1555 KINGSLEY AVE
Second Line	:	SUITE 503
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-9207
Country	:	US
Telephone Number	:	904-278-5088
Fax Number	:	904-264-4910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/22/2011

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Directions to “ DR. MICHAEL S. GILLIGAN M.D.” Practice Location

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