Provider Demographics
NPI:1467758987
Name:GREGORY L. CAMMELL, M.D.,PLC
Entity Type:Organization
Organization Name:GREGORY L. CAMMELL, M.D.,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-241-6380
Mailing Address - Street 1:4124 56TH ST SW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-9494
Mailing Address - Country:US
Mailing Address - Phone:616-241-6380
Mailing Address - Fax:616-608-5347
Practice Address - Street 1:4124 56TH ST SW
Practice Address - Street 2:SUITE 2
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418-9494
Practice Address - Country:US
Practice Address - Phone:616-241-6380
Practice Address - Fax:616-608-5347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058848207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1467758987Medicaid
MI0D10737OtherBCBSM
MIMI4274Medicare PIN