Healthcare Provider Details

I. General information

NPI: 1194720284
Provider Name (Legal Business Name): GREGORY J CERILLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E. HURON RIVER DR.
YPSILANTI MI
48197
US

IV. Provider business mailing address

PO BOX 0446 24 FRANK LLOYD WRIGHT DR. LOBBY J
ANN ARBOR MI
48106
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-7017
  • Fax: 734-712-2844
Mailing address:
  • Phone: 419-291-5150
  • Fax: 419-479-6173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35069105
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number4301104239
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number4301104239
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: