Provider Demographics
NPI:1053571620
Name:GILLIS, MARCUM G (MD)
Entity type:Individual
Prefix:DR
First Name:MARCUM
Middle Name:G
Last Name:GILLIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2025 FRONTIS PLAZA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5663
Mailing Address - Country:US
Mailing Address - Phone:336-768-6211
Mailing Address - Fax:336-768-6869
Practice Address - Street 1:195 KIMEL PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6967
Practice Address - Country:US
Practice Address - Phone:336-768-6211
Practice Address - Fax:336-768-6869
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2024-08-08
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Provider Licenses
StateLicense IDTaxonomies
NC2011-01846207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1053571620Medicaid