Provider Demographics
NPI:1316614233
Name:GILLIAM-WOOD, CARLI (QIDP)
Entity type:Individual
Prefix:
First Name:CARLI
Middle Name:
Last Name:GILLIAM-WOOD
Suffix:
Gender:F
Credentials:QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6375 KOLB AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2336
Mailing Address - Country:US
Mailing Address - Phone:313-550-2291
Mailing Address - Fax:
Practice Address - Street 1:6375 KOLB AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2336
Practice Address - Country:US
Practice Address - Phone:313-550-2291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist