Healthcare Provider Details

I. General information

NPI: 1164579025
Provider Name (Legal Business Name): MICHAEL GILLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 SIERRA ROSE DR STE 3A
RENO NV
89511-2060
US

IV. Provider business mailing address

655 SIERRA ROSE DR STE 3A
RENO NV
89511-2060
US

V. Phone/Fax

Practice location:
  • Phone: 775-829-7600
  • Fax: 775-824-5502
Mailing address:
  • Phone: 775-829-7600
  • Fax: 775-824-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number16941
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: