Individual
MICHELLE GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
21752 MCCORMICK ST, GROSSE POINTE, MI 48236-2110
(313) 587-1416
Mailing address
21752 MCCORMICK ST, GROSSE POINTE, MI 48236-2110
(313) 587-1416
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0124205
—
MI
Enumeration date
08/13/2013
Last updated
08/13/2013
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