Provider Demographics
NPI:1871663369
Name:STEVEN N GERVAE MD PC
Entity Type:Organization
Organization Name:STEVEN N GERVAE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:GERVAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:906-884-2824
Mailing Address - Street 1:751 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTONAGON
Mailing Address - State:MI
Mailing Address - Zip Code:49953-1450
Mailing Address - Country:US
Mailing Address - Phone:906-884-2824
Mailing Address - Fax:906-884-2861
Practice Address - Street 1:751 S 7TH ST
Practice Address - Street 2:
Practice Address - City:ONTONAGON
Practice Address - State:MI
Practice Address - Zip Code:49953-1450
Practice Address - Country:US
Practice Address - Phone:906-884-2824
Practice Address - Fax:906-884-2861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISG028728261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1042838Medicaid
MI0662861Medicare ID - Type Unspecified
MI1042838Medicaid