Provider Demographics
NPI:1053336206
Name:GILMORE, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GILMORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04211-1328
Mailing Address - Country:US
Mailing Address - Phone:207-784-9185
Mailing Address - Fax:207-784-1594
Practice Address - Street 1:824 STILLWATER AVE
Practice Address - Street 2:STE B
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3614
Practice Address - Country:US
Practice Address - Phone:207-941-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME0355Medicare ID - Type Unspecified
MEG91488Medicare UPIN