Provider Demographics
NPI:1780606814
Name:TOVATT, GERALD L (DO)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:L
Last Name:TOVATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W. CASS
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838
Mailing Address - Country:US
Mailing Address - Phone:231-250-8642
Mailing Address - Fax:
Practice Address - Street 1:615 W CASS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-1769
Practice Address - Country:US
Practice Address - Phone:231-250-8642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGT007643207Q00000X
AZ4503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE25944Medicare UPIN
AZZ119493Medicare PIN
AZZ119480Medicare PIN