Doctor Name: | DR. JENNIFER LEE GILMORE |
NPI Number: | 1043228653 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.O |
License Number: | 5101012812 |
Business Practice Address: | 138 Service Rd Ste A233 East Lansing, MI - 488241376 |
Business Phone Number: | 5174326144 |
Business Fax Number: | 5174326150 |
Mailing Address: | A439 E Fee Hall, EAST LANSING |
State: | MI |
Postal Code: | 488241316 |
Phone Number: | 5173534467 |
Fax Number: | |
NPI Enumeration Date: | 08/03/2006 |
NPI Last Update Date: | 12/07/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204D00000X |
License Number: | 5101012812 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
Taxonomy Specialization: | |
Taxonomy Definition: |