MEDICARE: DR. MICHELE MARIE JEAN-GILLES PHD

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	103TC0700X	Clinical Psychologist	PY5592	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366630428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE MARIE JEAN-GILLES PHD

Provider Business Mailing Address
First Line	:	1909 TYLER ST
Second Line	:	SUITE 504
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4527
Country	:	US
Telephone Number	:	954-929-7515
Fax Number	:	954-929-7510

Provider Business Practice Location Address
First Line	:	1909 TYLER ST
Second Line	:	SUITE 504
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4527
Country	:	US
Telephone Number	:	954-929-7515
Fax Number	:	954-929-7510

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

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	10/12/2007

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