Provider Demographics
NPI:1417997297
Name:GONDEK, MICHAEL RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RICHARD
Last Name:GONDEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 N VERITY RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48657-9391
Mailing Address - Country:US
Mailing Address - Phone:989-687-6398
Mailing Address - Fax:
Practice Address - Street 1:HEALTH SERVICES - EDC
Practice Address - Street 2:THE DOW CHEMICAL CO
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48674-0001
Practice Address - Country:US
Practice Address - Phone:989-636-9150
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430104326282083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine