MEDICARE: DR. PHILIP ALAIN GILLY MD

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	207Q00000X	Family Medicine Physician	180754	NY
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	4301098753	MI

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	:	1609849868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP ALAIN GILLY MD

Provider Business Mailing Address
First Line	:	6773 W MAPLE RD
Second Line	:	HENRY FORD MAPLEGROVE CENTER
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3013
Country	:	US
Telephone Number	:	248-661-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	8623 N WAYNE RD STE 104
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-1137
Country	:	US
Telephone Number	:	734-469-2770
Fax Number	:	734-793-5312

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	05/03/2023

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