Individual
MATTHEW JUSTIN GAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 N TELEGRAPH RD, PONTIAC, MI 48341-1032
(800) 231-1127
Mailing address
1200 N TELEGRAPH RD, PONTIAC, MI 48341-1032
(800) 231-1127
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EWE23D2DQ2D
OTHER
MI
Enumeration date
12/29/2017
Last updated
12/29/2017
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