Healthcare Provider Details

I. General information

NPI: 1477762185
Provider Name (Legal Business Name): ANNA GEORGINA C. GILLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA GEORGINA CSITKOVITS

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 RONALD REAGAN PKWY B1100
AVON IN
46123-7085
US

IV. Provider business mailing address

PO BOX 1026
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-948-2700
  • Fax: 317-948-2959
Mailing address:
  • Phone: 317-777-6435
  • Fax: 317-777-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01066917
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: