Provider Information for 1780160283
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JULIE E GALLIVAN
Sex: Female
NPI: 1780160283
Last Updated: 2024-05-22
Certification Date: 2024-05-22
Certification Date: 2024-05-22
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1780160283 | ||||||||
| Enumeration Date | 2018-07-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 194 BROWN RD BAILEY, MI 49303-9782 United States Phone: 616-432-7551 | Fax: | ||||||||
| Primary Practice Address | 11 N MAPLE ST GRANT, MI 49327-7900 United States Phone: 231-834-0444 | Fax:231-834-0200 | ||||||||
| Secondary Practice Address(es) | 5242 PLAINFIELD AVE NE STE E 96 E 120TH ST | ||||||||
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