Provider Demographics
NPI:1558321885
Name:GUREVITCH, DAVID (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GUREVITCH
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32270 TELEGRAPH RD
Mailing Address - Street 2:STE 240
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2456
Mailing Address - Country:US
Mailing Address - Phone:248-593-1717
Mailing Address - Fax:248-593-1711
Practice Address - Street 1:32270 TELEGRAPH RD
Practice Address - Street 2:STE 240
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2456
Practice Address - Country:US
Practice Address - Phone:248-593-1717
Practice Address - Fax:249-593-1711
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010465622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0636115OtherBCBS
A79702Medicare UPIN
P40360001Medicare PIN
0636115OtherBCBS