Individual
STACEY GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
2630 UNION LAKE RD, SUITE 100, COMMERCE TOWNSHIP, MI 48382-3582
(248) 360-1200
(248) 360-6182
Mailing address
24 FRANK LLOYD WRIGHT DR LBBY J2000, ANN ARBOR, MI 48105-9484
(734) 747-6766
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
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