Provider Demographics
NPI:1558370197
Name:DOCKS, GARY WOLK (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WOLK
Last Name:DOCKS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:18161 W 13 MILE RD
Mailing Address - Street 2:D-2
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1113
Mailing Address - Country:US
Mailing Address - Phone:248-258-0001
Mailing Address - Fax:248-258-6779
Practice Address - Street 1:18810 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-4014
Practice Address - Country:US
Practice Address - Phone:248-646-5209
Practice Address - Fax:248-203-6927
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI000785213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4848024Medicaid
MI4848024Medicaid
MIOP1234OMedicare ID - Type Unspecified