Provider Demographics
NPI:1346491818
Name:GANGEL, MICHAEL GENE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GENE
Last Name:GANGEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2651 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4200
Mailing Address - Country:US
Mailing Address - Phone:330-864-8008
Mailing Address - Fax:330-864-1207
Practice Address - Street 1:2651 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4200
Practice Address - Country:US
Practice Address - Phone:330-864-8008
Practice Address - Fax:330-864-1207
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2016-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-121958208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH0089610Medicaid
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #