Provider Demographics
NPI:1316902091
Name:GILLIAM, HAYWOOD S (MD)
Entity type:Individual
Prefix:
First Name:HAYWOOD
Middle Name:S
Last Name:GILLIAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:202 SO PARK ST
Mailing Address - Street 2:MERITER HOSPITAL - 10 TOWER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715
Mailing Address - Country:US
Mailing Address - Phone:608-417-6387
Mailing Address - Fax:608-417-6198
Practice Address - Street 1:202 SO PARK ST
Practice Address - Street 2:MERITER HOSPITAL
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715
Practice Address - Country:US
Practice Address - Phone:608-417-6387
Practice Address - Fax:608-417-6198
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI30734208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31533000Medicaid
WI31533000Medicaid
E19872Medicare UPIN