Provider Demographics
NPI:1659385219
Name:MAHONEY, GERARD J (DO)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:J
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 FRANKFORT HWY
Mailing Address - Street 2:
Mailing Address - City:BENZONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49616-9654
Mailing Address - Country:US
Mailing Address - Phone:231-882-9661
Mailing Address - Fax:231-882-9616
Practice Address - Street 1:826 FOREST AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635
Practice Address - Country:US
Practice Address - Phone:231-352-5285
Practice Address - Fax:231-352-6384
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF94220Medicare UPIN
MIN38430005Medicare PIN