Healthcare Provider Details

I. General information

NPI: 1821052440
Provider Name (Legal Business Name): JAMES WILLARD GILSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 N HAGGERTY RD
CANTON MI
48187
US

IV. Provider business mailing address

6200 N HAGGERTY RD
CANTON MI
48187-3605
US

V. Phone/Fax

Practice location:
  • Phone: 734-526-8860
  • Fax: 734-353-4108
Mailing address:
  • Phone: 800-444-6110
  • Fax: 866-642-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601003240
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: