Provider Demographics
NPI:1255677266
Name:GANKA SPASSOVA MD PLLC
Entity Type:Organization
Organization Name:GANKA SPASSOVA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GANKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPASSOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-284-6338
Mailing Address - Street 1:18770 FARMINGTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3292
Mailing Address - Country:US
Mailing Address - Phone:734-284-6338
Mailing Address - Fax:734-293-0985
Practice Address - Street 1:1307 FORD AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-3823
Practice Address - Country:US
Practice Address - Phone:734-284-6338
Practice Address - Fax:734-282-7390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty