Individual
DR. GAVIN MARK AMBROSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9601 TOWNLINE RD, MINOCQUA, WI 54548-9099
(715) 358-1000
Mailing address
31420 FAIRFAX ST, LIVONIA, MI 48152-1543
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301105071
MI
208600000X
Surgery Physician
Primary
70554-20
WI
Other
Enumeration date
06/03/2014
Last updated
06/19/2019
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