MEDICARE: BENJAMIN JOHN GILLIOTTE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	35.056649	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184626855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN JOHN GILLIOTTE MD

Provider Business Mailing Address
First Line	:	30 E APPLE ST
Second Line	:	STE L200
City	:	DAYTON
State	:	OH
Zip	:	45409-2932
Country	:	US
Telephone Number	:	937-208-2020
Fax Number	:	937-208-2109

Provider Business Practice Location Address
First Line	:	30 E APPLE ST
Second Line	:	STE L200
City	:	DAYTON
State	:	OH
Zip	:	45409-2932
Country	:	US
Telephone Number	:	937-208-2020
Fax Number	:	937-208-2109

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	11/15/2013

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