Provider Demographics
NPI:1144239559
Name:GORDON, JAMES J (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:GORDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27420
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:405-792-8910
Practice Address - Street 1:39475 LEWIS DR STE 200
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2980
Practice Address - Country:US
Practice Address - Phone:248-715-3400
Practice Address - Fax:248-715-3400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054621207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4474953Medicaid
MION61020Medicare ID - Type Unspecified
MI4474953Medicaid