Provider Demographics
NPI:1790876241
Name:CAPITAL MEDICAL ASSOC. PC
Entity Type:Organization
Organization Name:CAPITAL MEDICAL ASSOC. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:GACH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-851-2083
Mailing Address - Street 1:5385 TERENCE CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2555
Mailing Address - Country:US
Mailing Address - Phone:248-851-2083
Mailing Address - Fax:248-855-2130
Practice Address - Street 1:5385 TERENCE CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-2555
Practice Address - Country:US
Practice Address - Phone:248-851-2083
Practice Address - Fax:248-855-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJG005927208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA055632430OtherBLUE CROSS
MA055632430OtherBLUE CROSS
MI5632430Medicare PIN