Provider Demographics
NPI:1811001662
Name:GELL, KARYN E (MD)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:E
Last Name:GELL
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 1:970 PARCHMENT DRIVE SE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-949-4840
Mailing Address - Fax:616-949-3531
Practice Address - Street 1:970 PARCHMENT DRIVE SE
Practice Address - Street 2:SUITE 203
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-949-4840
Practice Address - Fax:616-949-3531
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051149207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110D11480OtherBCBSM GROUP PRACTICE NUMB
MI2812882Medicaid
MI0411024OtherBCBSM INDIVIDUAL NUMBER
MI0M98890001Medicare ID - Type UnspecifiedGROUP NUMBER
030002235Medicare ID - Type UnspecifiedRAILROAD
MI0411024OtherBCBSM INDIVIDUAL NUMBER