Provider Demographics
NPI:1356353353
Name:JASBECK, GARY (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:JASBECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:P.O. BOX 0446, LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:870 E ARKONA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-9770
Practice Address - Country:US
Practice Address - Phone:734-439-2429
Practice Address - Fax:734-439-0200
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301062958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine