Provider Demographics
NPI:1033186820
Name:ERRIGO, GARY GIRARD (PA C)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:GIRARD
Last Name:ERRIGO
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N MELBORN
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128
Mailing Address - Country:US
Mailing Address - Phone:313-561-8779
Mailing Address - Fax:
Practice Address - Street 1:17515 W NINE MILE ROAD
Practice Address - Street 2:SUITE 340
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-569-2695
Practice Address - Fax:248-569-7250
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002523363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P06370003OtherMEDICARE
MI700F312990OtherBCBS ID
MI0P06380003OtherMEDICARE