Individual
MS. GABRIELLE AMANDA DISMUKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.T.
Contact information
Practice address
7700 2ND AVE STE 410, DETROIT, MI 48202-2411
(313) 986-1100
(313) 338-3082
Mailing address
3739 RIVARD ST, DETROIT, MI 48207-4740
(248) 785-7617
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
10/16/2013
Last updated
10/16/2013
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