Provider Demographics
NPI:1710079256
Name:DOSKOCH, GERALYN (MD)
Entity Type:Individual
Prefix:
First Name:GERALYN
Middle Name:
Last Name:DOSKOCH
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 1:14705 W UPRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1949
Mailing Address - Country:US
Mailing Address - Phone:231-547-6519
Mailing Address - Fax:231-547-5404
Practice Address - Street 1:14705 W UPRIGHT ST
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1949
Practice Address - Country:US
Practice Address - Phone:231-547-6520
Practice Address - Fax:231-547-5404
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065473208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381459366062OtherCOMMUNITY CHOICE PIN#
MI4301065473OtherBC LICENSE NUMBER
MIGD065473OtherBLUE SHIELD LICENSE NUM
MI4847260Medicaid
MIG09324Medicare UPIN
MIGD065473OtherBLUE SHIELD LICENSE NUM