Individual
STACEY GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301056348
MI
208000000X
Pediatrics Physician
SG056348
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3053189
—
MI
Enumeration date
08/08/2006
Last updated
07/06/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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