Provider Demographics
NPI:1508933839
Name:MACINTYRE, GAIL E (DO)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:E
Last Name:MACINTYRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37399 GARFIELD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2958
Mailing Address - Country:US
Mailing Address - Phone:586-228-2911
Mailing Address - Fax:586-228-2901
Practice Address - Street 1:37399 GARFIELD
Practice Address - Street 2:SUITE 203
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-2958
Practice Address - Country:US
Practice Address - Phone:586-228-2911
Practice Address - Fax:586-228-2901
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI5101012124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5500128OtherBCBS
MI4446476Medicaid
MIG19270Medicare UPIN
MI4446476Medicaid