Healthcare Provider Details

I. General information

NPI: 1174574255
Provider Name (Legal Business Name): ROBERT PATRICK GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4463 STATE ROUTE 66
MINSTER OH
45865-8727
US

IV. Provider business mailing address

200 SAINT CLAIR AVE GRAND LAKE PHYSICIAN PRACTICES
SAINT MARYS OH
45885-2400
US

V. Phone/Fax

Practice location:
  • Phone: 419-394-3387
  • Fax: 419-628-9501
Mailing address:
  • Phone: 419-394-3387
  • Fax: 419-628-4307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35040370
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: