Provider Demographics
NPI:1326762782
Name:GOSSAGE, LEWIS ALEXANDER
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:ALEXANDER
Last Name:GOSSAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 RESEARCH PARK DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2271
Mailing Address - Country:US
Mailing Address - Phone:734-971-0277
Mailing Address - Fax:
Practice Address - Street 1:3941 RESEARCH PARK DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2271
Practice Address - Country:US
Practice Address - Phone:734-971-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator