Provider Demographics
NPI:1487614343
Name:GIL-ACOSTA, ALCIDES E (MD)
Entity type:Individual
Prefix:
First Name:ALCIDES
Middle Name:E
Last Name:GIL-ACOSTA
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 1:103 E MANSION ST
Mailing Address - Street 2:RICKETSON BLDG
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1117
Mailing Address - Country:US
Mailing Address - Phone:269-781-2658
Mailing Address - Fax:269-781-2936
Practice Address - Street 1:103 E MANSION ST
Practice Address - Street 2:RICKETSON BLDG
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1117
Practice Address - Country:US
Practice Address - Phone:269-781-2658
Practice Address - Fax:269-781-2936
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI081034207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4462101Medicaid
MI4462101Medicaid
MIH37067Medicare UPIN