Provider Demographics
NPI:1700837721
Name:GALE, ALICE I (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:I
Last Name:GALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 W SAGINAW HWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1131
Mailing Address - Country:US
Mailing Address - Phone:517-323-2585
Mailing Address - Fax:517-323-2586
Practice Address - Street 1:7201 W SAGINAW HWY
Practice Address - Street 2:SUITE 215
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1131
Practice Address - Country:US
Practice Address - Phone:517-323-2585
Practice Address - Fax:517-323-2586
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAG037270207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2104560Medicaid
MI0703300022OtherBCBSM
MI0703300022OtherBLUE CARE NETWORK
MI0330002707Medicare ID - Type Unspecified
MI0703300022OtherBLUE CARE NETWORK