Provider Demographics
NPI:1407963234
Name:HOSEY, GARY EDWARD (DPM)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:EDWARD
Last Name:HOSEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64177 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2580
Mailing Address - Country:US
Mailing Address - Phone:810-329-0800
Mailing Address - Fax:810-329-6543
Practice Address - Street 1:64177 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-2580
Practice Address - Country:US
Practice Address - Phone:586-752-5770
Practice Address - Fax:586-752-5771
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001469213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1184890311OtherNPI TYPE 2
MI14076973234OtherNPI TYPE 1
MI2755490Medicaid
MIMI5095001OtherPTAN INDIVIDUAL
MIMI5095OtherPTAN ORGANIZATION
MI2755490Medicaid
MI4168510001Medicare NSC