Provider Demographics
NPI:1841936747
Name:GUMRO, JOSEPH M
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:GUMRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47240 WEAR RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-8678
Mailing Address - Country:US
Mailing Address - Phone:313-854-0800
Mailing Address - Fax:
Practice Address - Street 1:47240 WEAR RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-8678
Practice Address - Country:US
Practice Address - Phone:313-854-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications