Individual
MICHELLE GORMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2422 JOLLY RD STE 100, OKEMOS, MI 48864-3690
(517) 618-9507
Mailing address
2422 JOLLY RD STE 100, OKEMOS, MI 48864-3690
(517) 618-9507
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601005380
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144497148
—
MI
01
—
200000055800
PHP
MI
01
—
5331355
BCBS
MI
01
—
C36084082
MEDICARE
MI
Enumeration date
09/15/2008
Last updated
09/17/2021
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