Provider Demographics
NPI:1568432151
Name:GOLD, GERALD (DPM)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:GOLD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48324-1633
Mailing Address - Country:US
Mailing Address - Phone:248-682-6662
Mailing Address - Fax:248-682-2850
Practice Address - Street 1:3206 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:ORCHARD LAKE
Practice Address - State:MI
Practice Address - Zip Code:48324-1633
Practice Address - Country:US
Practice Address - Phone:248-682-6662
Practice Address - Fax:248-682-2850
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001648213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3463641Medicaid