Provider Demographics
NPI:1578994463
Name:GAGO IVF
Entity Type:Organization
Organization Name:GAGO IVF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JOANTHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-227-3232
Mailing Address - Street 1:2250 GENOA BUSINESS PARK DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7372
Mailing Address - Country:US
Mailing Address - Phone:810-227-3232
Mailing Address - Fax:810-227-3237
Practice Address - Street 1:2250 GENOA BUSINESS PARK DR STE 110
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7372
Practice Address - Country:US
Practice Address - Phone:810-227-3232
Practice Address - Fax:810-227-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069923174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4630655Medicaid
MII15246Medicare UPIN