Organization
GEORGE W GIBSON DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE W GIBSON M.D (OWNER)
(313) 930-0242
Entity
Organization
Contact information
Practice address
15201 W MCNICHOLS RD, DETROIT, MI 48235-3717
(313) 930-0242
(734) 451-0603
Mailing address
15201 W MCNICHOLS RD, DETROIT, MI 48235-3717
(313) 930-0242
(734) 451-0603
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101006424
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5101006424
PENDING
MI
Enumeration date
04/13/2012
Last updated
04/13/2012
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