Individual
MICHAEL GRAVINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
17330 NORTHLAND PARK CT, SUITE 201, SOUTHFIELD, MI 48075-4318
(248) 809-2853
Mailing address
17330 NORTHLAND PARK CT, SUITE 201, SOUTHFIELD, MI 48075-4318
(248) 809-2853
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005451
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
262331509
TAX ID
MI
Enumeration date
07/27/2009
Last updated
07/27/2009
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