MEDICARE: DR. HEATHER N GILLUM MD PSYCHIATRIST

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	2084P0800X	Psychiatry Physician	ME132677	FL
2	2084P0800X	Psychiatry Physician	236900	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881682227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER N GILLUM MD PSYCHIATRIST

Provider Business Mailing Address
First Line	:	434 W KENNEDY BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-6237
Country	:	US
Telephone Number	:	407-875-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	434 W KENNEDY BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810
Country	:	US
Telephone Number	:	407-875-3700
Fax Number	:

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	01/25/2019

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