Provider Demographics
NPI:1013039734
Name:GAMARRA, ROBERTO MAURO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:MAURO
Last Name:GAMARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:30055 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3230
Mailing Address - Country:US
Mailing Address - Phone:248-985-5000
Mailing Address - Fax:248-985-5500
Practice Address - Street 1:30055 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 250
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3230
Practice Address - Country:US
Practice Address - Phone:248-985-5000
Practice Address - Fax:248-985-5500
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301080488207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI007373844Medicare PIN
WI007052540Medicare PIN
WI002165003Medicare PIN