1851872279 NPI number — GILLIAN MARGARET CLIFFORD NP

Table of content: GILLIAN MARGARET CLIFFORD NP (NPI 1851872279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851872279 NPI number — GILLIAN MARGARET CLIFFORD NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLIFFORD
Provider First Name:
GILLIAN
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851872279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27140 CLAIRVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48127-1679
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-231-1887
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WESTERN WAYNE FAMILY HEALTH CENTERS
Provider Second Line Business Practice Location Address:
2700 HAMLIN BLVD.
Provider Business Practice Location Address City Name:
INKSTER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-561-5100
Provider Business Practice Location Address Fax Number:
313-565-0309
Provider Enumeration Date:
08/23/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  4704235517 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)