Provider Demographics
NPI:1407879620
Name:GADOWSKI, GERALD A (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A
Last Name:GADOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-2490
Mailing Address - Fax:231-487-6055
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-2490
Practice Address - Fax:231-487-6055
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006796207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0652400274OtherBLUE SHIELD INDIVIDUAL PI
MIP45990OtherBLUE CARE NETWORK
MI4355729Medicaid
MI0652400274OtherBLUE SHIELD INDIVIDUAL PI
MIOM75740007Medicare ID - Type Unspecified