Provider Demographics
NPI:1447257100
Name:GILLI, WILLIAM EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:GILLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8327 BRIMHALL RD
Mailing Address - Street 2:SUITE #704
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-4048
Mailing Address - Country:US
Mailing Address - Phone:661-829-7677
Mailing Address - Fax:661-679-6920
Practice Address - Street 1:8327 BRIMHALL RD
Practice Address - Street 2:SUITE #704
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-4048
Practice Address - Country:US
Practice Address - Phone:661-617-6750
Practice Address - Fax:661-617-6760
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG53033OtherCA LICENSE
CAGR0057501Medicaid
CAG53033OtherCA LICENSE
CAZZZ38298ZMedicare ID - Type UnspecifiedMEDICARE
CAGR0057501Medicaid