MEDICARE: JAMES R GILSDORF M.D.

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	208600000X	Surgery Physician	4301045438	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	DC6914	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101875	OTHER	MI	CARE CHOICE / PREF CHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	B48642	OTHER	MI	UPIN
4	0004109376	OTHER	MI	AETNA
5	0208110311	OTHER	MI	BCBSM
6	11276974	OTHER	MI	CAQH PROVIDER NUMBER
8	B48642	OTHER	MI	HAP

General Provider Information

NPI Number	:	1295794683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES R GILSDORF M.D.

Provider Business Mailing Address
First Line	:	200 ARNET ST
Second Line	:	SUITE 110
City	:	YPSILANTI
State	:	MI
Zip	:	48198-5753
Country	:	US
Telephone Number	:	734-483-0404
Fax Number	:	734-481-0844

Provider Business Practice Location Address
First Line	:	200 ARNET ST
Second Line	:	SUITE 110
City	:	YPSILANTI
State	:	MI
Zip	:	48198-5753
Country	:	US
Telephone Number	:	734-483-0404
Fax Number	:	734-481-0844

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

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	02/28/2008

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