Provider Demographics
NPI:1134179880
Name:GAMIAO, MICHAEL NAGTALON (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NAGTALON
Last Name:GAMIAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14555 LEVAN RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5083
Mailing Address - Country:US
Mailing Address - Phone:734-462-1233
Mailing Address - Fax:734-462-3044
Practice Address - Street 1:14555 LEVAN RD
Practice Address - Street 2:SUITE 404
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5083
Practice Address - Country:US
Practice Address - Phone:734-462-1233
Practice Address - Fax:734-462-3044
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301054509174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3422237Medicaid
MIP32100002Medicare PIN
MI3422237Medicaid