Provider Demographics
NPI:1063968618
Name:GILLESPIE, RACHEL M (DPM)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:M
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3055 HILTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1096
Mailing Address - Country:US
Mailing Address - Phone:248-965-2927
Mailing Address - Fax:248-965-2912
Practice Address - Street 1:1200 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-4439
Practice Address - Country:US
Practice Address - Phone:248-543-0600
Practice Address - Fax:248-543-0562
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002658213ES0103X
332B00000X
MI5901400351213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-0264Medicaid
MI23-0264Medicaid