Provider Demographics
NPI:1942290069
Name:GERBER, MICHAEL LOUIS (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LOUIS
Last Name:GERBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41400 DEQUINDRE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314
Mailing Address - Country:US
Mailing Address - Phone:586-731-7873
Mailing Address - Fax:586-731-7912
Practice Address - Street 1:41400 DEQUINDRE RD
Practice Address - Street 2:STE 100
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314
Practice Address - Country:US
Practice Address - Phone:586-731-7873
Practice Address - Fax:586-731-7912
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIME001014213ES0103X
MIMG001014261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4342936Medicaid
29510001Medicare ID - Type UnspecifiedID
MIOP29510Medicare PIN
T34127Medicare UPIN
MI4342936Medicaid