Doctor Name: | TIMOTHY G GILLUM |
NPI Number: | 1316994791 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 01055912A |
Business Practice Address: | 801 W Gardner Dr Marion, IN - 469521819 |
Business Phone Number: | 7656514278 |
Business Fax Number: | 7656646445 |
Mailing Address: | 801 W Gardner Dr, MARION |
State: | IN |
Postal Code: | 469521819 |
Phone Number: | 7656514278 |
Fax Number: | 7656646445 |
NPI Enumeration Date: | 05/30/2006 |
NPI Last Update Date: | 05/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 01055912A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |