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NPI Code Detail

MEDICARE: DR. OLIVER D GILLIAM M.D.

MEDICARE: DR. OLIVER D GILLIAM 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
1207RG0100XGastroenterology Physician01035882AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5100010837OTHERINRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22738533002OTHERINCIGNA
3000000084427OTHERINANTHEM
44667992OTHERINAETNA

General Provider Information

NPI Number : 1497759765
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OLIVER D GILLIAM M.D.
Provider Business Mailing Address
First Line : 17501 GENERATIONS DR
Second Line :
City : SOUTH BEND
State : IN
Zip : 46635-1589
Country : US
Telephone Number : 574-234-0049
Fax Number : 574-251-2861
Provider Business Practice Location Address
First Line : 17501 GENERATIONS DR
Second Line :
City : SOUTH BEND
State : IN
Zip : 46635-1589
Country : US
Telephone Number : 574-234-0049
Fax Number : 574-251-2861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2005
Last Update Date : 01/21/2011

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Directions to “ DR. OLIVER D GILLIAM M.D.” Practice Location

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