Individual
CHARLES GENGHIS LINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6483 CITATION DR, SUITE B, CLARKSTON, MI 48346-2994
(248) 922-3074
(248) 922-3081
Mailing address
6483 CITATION DR, SUITE B, CLARKSTON, MI 48346-2994
(248) 922-3074
(248) 922-3081
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101241384
VA
207Q00000X
Family Medicine Physician
Primary
4301095854
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881818615
—
MI
Enumeration date
04/12/2007
Last updated
12/16/2011
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