Organization
LARRY GIDEON, M D
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY GIDEON M D (PRESIDENT)
(810) 392-2192
Entity
Organization
Contact information
Practice address
609 BUNNELL M 19, MEMPHIS, MI 48041
(810) 392-2192
Mailing address
609 BUNNELL M 19, MEMPHIS, MI 48041
(810) 392-2192
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
LG407549
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LG407549
STATE LICENCE
MI
Enumeration date
06/01/2007
Last updated
08/22/2020
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