# WILLIE B GIBSON MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043549181
- **Authorized official:** CHERYL L FOSTER (OFFICE MANAGER)
- **Authorized official phone:** (313) 535-9366

## Contact information

- **Practice address:** 18300 W MCNICHOLS RD, DETROIT, MI 48219-4162
- **Practice address phone:** (313) 535-9366
- **Practice address fax:** (313) 534-1970
- **Mailing address:** 18300 W MCNICHOLS RD, DETROIT, MI 48219-4162
- **Mailing address phone:** (313) 535-9366
- **Mailing address fax:** (313) 534-1970

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | 4301035487 | MI | Yes |

## Other

- **Enumeration date:** 12/21/2009
- **Last updated:** 06/23/2010