Provider Demographics
NPI:1558329789
Name:GILLIGAN, MICHAEL S (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:GILLIGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11945 SAN JOSE BLVD.
Mailing Address - Street 2:BLDG 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:1555 KINGSLEY AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-9207
Practice Address - Country:US
Practice Address - Phone:904-278-5088
Practice Address - Fax:904-264-4910
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53014208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
05911OtherBCBS FL
204077OtherAVMED
0447391OtherCIGNA
FL020032009OtherRAILROAD MEDICARE
4045261OtherAETNA
FL020032009OtherRAILROAD MEDICARE
4045261OtherAETNA