Healthcare Provider Details

I. General information

NPI: 1770278822
Provider Name (Legal Business Name): CHARLES GILLEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # JJ24
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # JJ24
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number307479
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number307479
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: