Healthcare Provider Details

I. General information

NPI: 1235045006
Provider Name (Legal Business Name): CAMERON GILLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 E NORTH ST
KALAMAZOO MI
49007-3535
US

IV. Provider business mailing address

4373 MONTEREY PINE AVE
PORTAGE MI
49024-9052
US

V. Phone/Fax

Practice location:
  • Phone: 269-370-3590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberM5161224
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: