Provider Demographics
NPI:1700046307
Name:GAVORIN, DENISE ELAINE (DO)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ELAINE
Last Name:GAVORIN
Suffix:
Gender:F
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 1:455 BARCLAY CIR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4774
Mailing Address - Country:US
Mailing Address - Phone:248-852-9596
Mailing Address - Fax:248-852-9453
Practice Address - Street 1:455 BARCLAY CIR
Practice Address - Street 2:SUITE D
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4774
Practice Address - Country:US
Practice Address - Phone:248-852-9596
Practice Address - Fax:248-852-9453
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080F326810OtherBLUE CROSS BLUE SHIELD OF MICHIGAN GROUP
MI5632330OtherBCBSM PERSONAL
MI0P15420007Medicare PIN