Provider Demographics
NPI:1578866620
Name:GARY F KOLOFF MD PC
Entity Type:Organization
Organization Name:GARY F KOLOFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:KOLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-553-2434
Mailing Address - Street 1:28423 ORCHARD LAKE RD STE 212
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2971
Mailing Address - Country:US
Mailing Address - Phone:248-553-2434
Mailing Address - Fax:734-240-8557
Practice Address - Street 1:28423 ORCHARD LAKE RD STE 212
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2971
Practice Address - Country:US
Practice Address - Phone:248-553-2434
Practice Address - Fax:734-240-8557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGK0485562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0631131Medicare PIN