Provider Demographics
NPI:1467624379
Name:G&M MANAGEMENT
Entity Type:Organization
Organization Name:G&M MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:FOSNAUGH
Authorized Official - Last Name:AVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-353-6880
Mailing Address - Street 1:20240 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2426
Mailing Address - Country:US
Mailing Address - Phone:248-353-6880
Mailing Address - Fax:248-353-6887
Practice Address - Street 1:20240 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2426
Practice Address - Country:US
Practice Address - Phone:248-353-6880
Practice Address - Fax:248-353-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical