Provider Demographics
NPI:1518453109
Name:GIBSON, MACY ANN (DO)
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:ANN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MACY
Other - Middle Name:ANN
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR STE J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:
Practice Address - Street 1:1750 S TELEGRAPH RD STE 108
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0177
Practice Address - Country:US
Practice Address - Phone:248-334-4505
Practice Address - Fax:248-253-0347
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101024366207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology