Provider Demographics
NPI:1871635607
Name:DAVID GUREVITCH MD PC
Entity Type:Organization
Organization Name:DAVID GUREVITCH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-593-1717
Mailing Address - Street 1:32270 TELEGRAPH RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-2456
Mailing Address - Country:US
Mailing Address - Phone:248-593-1717
Mailing Address - Fax:248-593-1711
Practice Address - Street 1:32270 TELEGRAPH RD
Practice Address - Street 2:SUITE 240
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-2456
Practice Address - Country:US
Practice Address - Phone:248-593-1717
Practice Address - Fax:248-593-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDG046562103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0636115OtherBCBS
0636115OtherBCBS
0P40360Medicare PIN