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General NPI Number Information
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NPI Number | 1669454013
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Entity Type | Individual
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Provider Name | MICHELLE M GILLIATTE D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 20905 E 12 MILE RD STE 100
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City | ROSEVILLE
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State | MI
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Zip | 48066-6501
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Country | US
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Telephone | 586-772-3500
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Fax | 586-772-6540
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Provider Business Mailing Address
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Address Line | 20905 E 12 MILE RD STE 100
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City | ROSEVILLE
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State | MI
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Zip | 48066-6501
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Country | US
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Telephone | 586-772-3500
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Fax | 586-772-6540
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901002041
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License Number State | MI
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