IndividualActive
Carolyn Gilley
NPI 1043749617 · Primary Care Clinic/Center · Random Lake, WI
Provider details
- NPI number
- 1043749617
- Entity type
- Individual
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Ambulatory Health Care Facilities
Practice location
220 Carroll St
Random Lake, WI 53075-1795
Phone: (800) 490-3146
Approximate (ZIP-level) locationGet directions
Mailing address
220 Carroll St
Random Lake, WI 53075-1795
Registry dates
- Enumerated
- 2017-06-07
- Last updated
- 2017-06-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.