Provider Demographics
NPI:1801233614
Name:GEMUS, DONNELL ANTHONY JR (PA-C)
Entity type:Individual
Prefix:
First Name:DONNELL
Middle Name:ANTHONY
Last Name:GEMUS
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:DON
Other - Middle Name:
Other - Last Name:GEMUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 2470
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-7470
Mailing Address - Country:US
Mailing Address - Phone:734-344-7432
Mailing Address - Fax:734-344-7431
Practice Address - Street 1:1645 N DIXIE HWY STE 2
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-5231
Practice Address - Country:US
Practice Address - Phone:734-344-3472
Practice Address - Fax:734-344-7431
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006669363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant