Provider Demographics
NPI:1811984487
Name:AWERBUCH MD PLLC, GAVIN I (MD)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:I
Last Name:AWERBUCH MD PLLC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5889 BAY RD
Mailing Address - Street 2:STE #104
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604
Mailing Address - Country:US
Mailing Address - Phone:989-791-7999
Mailing Address - Fax:989-791-7996
Practice Address - Street 1:5889 BAY RD
Practice Address - Street 2:STE #104
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604
Practice Address - Country:US
Practice Address - Phone:989-791-7999
Practice Address - Fax:989-791-7996
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43014052262084N0400X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2582817Medicaid
MIB43959Medicare UPIN
B43959Medicare UPIN
MI0091308Medicare PIN
0091308Medicare PIN