MEDICARE: ERIN KRISTEN GILLARD

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	390200000X	Student in an Organized Health Care Education/Training Program	5302042611	MI

General Provider Information

NPI Number	:	1588199145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN KRISTEN GILLARD

Provider Business Mailing Address
First Line	:	25 MICHIGAN ST NE STE 7000
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2570
Country	:	US
Telephone Number	:	248-808-1298
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 MICHIGAN ST NE STE 7000
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2570
Country	:	US
Telephone Number	:	248-808-1298
Fax Number	:

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

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	04/20/2017

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Directions to “ ERIN KRISTEN GILLARD ” Practice Location

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