Brent W Gillum D O PLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

007845 Issued in MI

Legal business name

BRENT W GILLUM D O PLC

Practice address

4727 Saint Antoine St
Suite 210
Detroit, MI 48201-1461

Phone

(313) 831-3066

Fax

(313) 831-8438

NPI assigned

Jun 6, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brent Winston Gillum, D.O.NPI 1659347821

Title

Physican

Phone

(313) 831-3066

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brent Winston Gillum, D.O.

  • Obstetrics & Gynecology Physician
  • Detroit, MI
  • NPI 1659347821
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194393600000",
    "number": "1710926670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4727 SAINT ANTOINE ST",
            "address_2": "SUITE 210",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011461",
            "telephone_number": "313-831-3066",
            "fax_number": "313-831-8438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4727 SAINT ANTOINE ST",
            "address_2": "SUITE 210",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011461",
            "telephone_number": "313-831-3066",
            "fax_number": "313-831-8438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENT W GILLUM D O PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-06",
        "last_updated": "2007-11-07",
        "status": "A",
        "authorized_official_last_name": "GILLUM",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "WINSTON",
        "authorized_official_title_or_position": "PHYSICAN",
        "authorized_official_telephone_number": "313-831-3066",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "007845",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4850953",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Elizabeth-Shovlin Brennan, M.D.
• Matthew Brennan
• Sasha Nicole Brennan
• Joseph Dale Brenner, MD
• Scott Ian Brensel, DO
• Camiryn Brent, RN
• Charese Brent
• Cierra Brent
• Carly Brescacin
• Adrienna Brewer

• Obstetrics & Gynecology Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Obstetrics & Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.