Provider Demographics
NPI:1205191202
Name:GATES, CANDICE KIMBERLY (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:KIMBERLY
Last Name:GATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR STE J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:19000 ST JOES PKWY STE 210
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1477
Practice Address - Country:US
Practice Address - Phone:734-655-8250
Practice Address - Fax:734-655-8255
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301101648207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology