MEDICARE: MICHAEL D GILLETT M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	43656	MN
2	208800000X	Urology Physician	5878	SD

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00337027	OTHER	SD	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1619954542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL D GILLETT M.D.

Provider Business Mailing Address
First Line	:	201 W 69TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2403
Country	:	US
Telephone Number	:	605-336-0635
Fax Number	:	605-271-0543

Provider Business Practice Location Address
First Line	:	201 W 69TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2403
Country	:	US
Telephone Number	:	605-336-0635
Fax Number	:	605-271-0543

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	02/01/2012

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax:

201 W 69TH ST
SIOUX FALLS, SD
57108-2403