Provider Demographics
NPI:1114239373
Name:GAYLES, CARLOS BRUNO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:BRUNO
Last Name:GAYLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:381 SHAGBARK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1820
Mailing Address - Country:US
Mailing Address - Phone:248-651-0570
Mailing Address - Fax:248-651-4205
Practice Address - Street 1:9301 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-2532
Practice Address - Country:US
Practice Address - Phone:734-941-1000
Practice Address - Fax:734-941-9836
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301026189208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice