Provider Demographics
NPI:1710920996
Name:PAMELA M GEPPERT DO PLLC
Entity Type:Organization
Organization Name:PAMELA M GEPPERT DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GEPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-414-7231
Mailing Address - Street 1:9333 N HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4622
Mailing Address - Country:US
Mailing Address - Phone:734-414-7231
Mailing Address - Fax:734-414-7232
Practice Address - Street 1:9333 N HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4622
Practice Address - Country:US
Practice Address - Phone:734-414-7231
Practice Address - Fax:734-414-7232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080H232150OtherBCN GRP
MI1710920996Medicaid
MI080H232150OtherBCBS GRP
MI1710920996Medicaid
MI0N91500Medicare PIN