Individual
CARMELINA GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
850 W NORTH ST STE 100, JACKSON, MI 49202-3196
(877) 852-8463
(517) 841-3034
Mailing address
850 W NORTH ST STE 104, JACKSON, MI 49202-3196
(877) 852-8463
(517) 817-0144
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
4301063145
MI
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
4301063145
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180044966
RAILROAD MEDICARE
—
01
—
180C846310
BCBSM
MI
01
—
180H149970
BCBSM
MI
05
—
4380786
—
MI
05
—
4496389
—
MI
Enumeration date
10/11/2005
Last updated
07/21/2022
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