Provider Demographics
NPI:1013908532
Name:MOSBY, GERARD M (MD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:M
Last Name:MOSBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:DEPT 999360 PO BOX 33738
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-3738
Mailing Address - Country:US
Mailing Address - Phone:810-720-5715
Mailing Address - Fax:810-732-0891
Practice Address - Street 1:10201 E JEFFERSON AVE
Practice Address - Street 2:SUITE 201A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3149
Practice Address - Country:US
Practice Address - Phone:313-821-3777
Practice Address - Fax:313-824-3777
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2015-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301051836208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2673288Medicaid
MI4502397Medicaid
MI4502397Medicaid
MI2673288Medicaid