Provider Demographics
NPI:1053313379
Name:GOSSAGE, DAVID D (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:GOSSAGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W CARLETON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1202
Mailing Address - Country:US
Mailing Address - Phone:517-439-2020
Mailing Address - Fax:517-437-5577
Practice Address - Street 1:50 W CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1202
Practice Address - Country:US
Practice Address - Phone:517-439-2020
Practice Address - Fax:517-437-5577
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011362207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4247015Medicaid
MIG11867Medicare UPIN
MI4247015Medicaid