Individual
GINA MARIE D'AMBROSIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
36123 SCHOOLCRAFT RD, LIVONIA, MI 48150-1216
(734) 464-0887
(734) 402-0254
Mailing address
36123 SCHOOLCRAFT RD, LIVONIA, MI 48150-1216
(734) 793-6140
(865) 560-8948
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101014605
MI
208M00000X
Hospitalist Physician
5101014605
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790789055
NPI #
MI
05
—
4846745
—
MI
01
—
700F329470
BLUE CROSS CPIN
MI
Enumeration date
06/02/2005
Last updated
11/16/2017
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