Provider Demographics
NPI:1588676399
Name:PEPPIN, GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:PEPPIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:4350 JACKSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1889
Practice Address - Country:US
Practice Address - Phone:734-761-2581
Practice Address - Fax:734-995-0425
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-12-14
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Provider Licenses
StateLicense IDTaxonomies
MI4301057654207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1588676399Medicaid