MEDICARE: DR. MICHAEL BARRY GELLIS 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	208200000X	Plastic Surgery Physician	4301030689	MI
2	208200000X	Plastic Surgery Physician	2735A	WY
3	208200000X	Plastic Surgery Physician	MD430264	PA
4	208200000X	Plastic Surgery Physician	30028	NC

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	:	1508997032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL BARRY GELLIS M.D.

Provider Business Mailing Address
First Line	:	36800 WOODWARD AVE
Second Line	:	SUITE 109
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-0915
Country	:	US
Telephone Number	:	248-642-4846
Fax Number	:	248-642-5313

Provider Business Practice Location Address
First Line	:	36800 WOODWARD AVE
Second Line	:	SUITE 109
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-0915
Country	:	US
Telephone Number	:	248-642-4846
Fax Number	:	248-642-5313

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	03/08/2010

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Directions to “ DR. MICHAEL BARRY GELLIS M.D.” Practice Location

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