Provider Demographics
NPI:1760445571
Name:DOUBLESTEIN, GARY L (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:DOUBLESTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-672-6600
Mailing Address - Fax:231-728-4691
Practice Address - Street 1:1675 LEAHY ST STE 201A
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5542
Practice Address - Country:US
Practice Address - Phone:231-672-6600
Practice Address - Fax:231-727-4444
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2018-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE25898Medicare UPIN