Provider Demographics
NPI:1942458567
Name:MICHAEL L. GAMBEL M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL L. GAMBEL M.D., P.C.
Other - Org Name:MY FAMILY DOCTOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAMBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-282-5502
Mailing Address - Street 1:12100 DIX TOLEDO RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3531
Mailing Address - Country:US
Mailing Address - Phone:734-282-5502
Mailing Address - Fax:734-282-7106
Practice Address - Street 1:12100 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3531
Practice Address - Country:US
Practice Address - Phone:734-282-5502
Practice Address - Fax:734-282-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4301042047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty