Devon Ross Gildea, MAT, AT, ATC
Individual provider Active NPI Athletic Trainer · Hopkins, MI
NPI 1790447167 · NPPES record last updated Oct 12, 2021
Key facts
- NPI
- 1790447167
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 2601002637 (MI)
- Practice address
- 333 S Clark St
Hopkins, MI 49328-9501 - Phone
- (269) 793-7616
- NPI assigned
- Oct 12, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2601002637 | MI | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2601002637 | MI | Yes |
Addresses
Primary practice location
333 S Clark St
Hopkins, MI 49328-9501
Mailing address
547 Cherry St SE Apt 1N
Grand Rapids, MI 49503-4749
Phone (269) 903-1794
Other providers in Hopkins, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.